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Verweij P.E.,Radboud University Nijmegen | Ananda-Rajah M.,General Medicine and Infectious Diseases Units | Andes D.,University of Wisconsin - Madison | Arendrup M.C.,Statens Serum Institute | And 17 more authors.
Drug Resistance Updates | Year: 2015

An international expert panel was convened to deliberate the management of azole-resistant aspergillosis. In culture-positive cases, in vitro susceptibility testing should always be performed if antifungal therapy is intended. Different patterns of resistance are seen, with multi-azole and pan-azole resistance more common than resistance to a single triazole. In confirmed invasive pulmonary aspergillosis due to an azole-resistant Aspergillus, the experts recommended a switch from voriconazole to liposomal amphotericin B (L-AmB; Ambisome®). In regions with environmental resistance rates of ≥10%, a voriconazole-echinocandin combination or L-AmB were favoured as initial therapy. All experts recommended L-AmB as core therapy for central nervous system aspergillosis suspected to be due to an azole-resistant Aspergillus, and considered the addition of a second agent with the majority favouring flucytosine. Intravenous therapy with either micafungin or L-AmB given as either intermittent or continuous therapy was recommended for chronic pulmonary aspergillosis due to a pan-azole-resistant Aspergillus. Local and national surveillance with identification of clinical and environmental resistance patterns, rapid diagnostics, better quality clinical outcome data, and a greater understanding of the factors driving or minimising environmental resistance are areas where research is urgently needed, as well as the development of new oral agents outside the azole drug class. © 2015 The Authors.

Strupp J.,University of Cologne | Hartwig A.,University of Cologne | Golla H.,University of Cologne | Galushko M.,University of Cologne | And 4 more authors.
Palliative Medicine | Year: 2012

Background: The situation for people feeling severely affected by Multiple Sclerosis (MS) remains largely unexamined and the term 'esevere MSf is not clearly defined. Aim: Our study describes this sub-group of patients utilizing exclusively a subjective inclusion criterion to analyse their reasons for feeling severely affected and document their perceived unmet needs. Design: A questionnaire with open- and closed-ended items addressing only patients feeling severely affected was sent out nationwide. Expanded Disability Status Score (EDSS) and subjectively severe affectedness were analysed for correlation. After dichotomizing both scores by a median split, the answers were allocated to these groups and tested for significant differences. Setting/participants: 1,110 questionnaires were analysed regarding the closed-ended questions while a subsample of 40% (n = 445) was analysed regarding the open-ended questions. Average age of participants was 51.87 years. Average time since diagnosis was 16.6 years. Main course of the disease was secondary progressive (35.5%). Results: The most frequently mentioned reasons for feeling severely affected were lack of mobility (56.4%) and fatigue (27.4%). Significant percentages for unmet needs were seen in the categories of funding services (31.0%), better social integration (24.7%) and medical support (25.2%). A significant correlation was observed between EDSS and subjectively felt affectedness (p ≤ 0.01). Motor disorders explained differences in patient needs behind a higher EDSS score; higher severe affectedness referred to other issues like dependency and immobility. Conclusions: EDSS is insufficient for usage as the sole instrument for measuring severe affectedness as it does not take into account other potential reasons. Complex patient needs necessitate multi-professional care as offered by palliative medicine. © 2012 The Author(s).

Schweer K.E.,Universitatsklinikum Cologne | Wittersheim M.,Universitatsklinikum Cologne | Bangard C.,Universitatsklinikum Cologne | Frank K.F.,Universitatsklinikum Cologne | Cornely O.A.,Center for Integrated Oncology Cologne Bonn
Deutsche Medizinische Wochenschrift | Year: 2014

Chronic pulmonary aspergillosis (CPA) is a rare complication in patients with either mild immunosuppression or various pulmonary diseases. Diagnosis and therapy are challenging because of unspecific symptoms like productive cough, weight loss, fever and haemoptysis. Differential diagnoses are manifold, and CPA is characterized by findings in chest CT and serologic proof of precipitins. Surgery is only recommended for simple aspergillomas. Recurrent prolonged courses of antifungal treatment yield satisfactory short-term outcome, but long-term prognosis is uncertain. We provide an overview of the literature and present four cases to illustrate disease diversity. © 2014 Georg Thieme Verlag KG Stuttgart New York.

Buecken R.,University of Cologne | Galushko M.,University of Cologne | Golla H.,University of Cologne | Strupp J.,University of Cologne | And 6 more authors.
Patient Education and Counseling | Year: 2012

Objective: Investigate multiple sclerosis patients' desire to communicate with their physicians about their disease progression and end-of-life issues. Methods: Persons meeting the inclusion criteria of feeling severely affected by MS were invited via the German MS society to complete a needs questionnaire. Replies to questions on physician empathy and wishes about communication regarding disease progression and death and dying were quantitatively analyzed. Endpoints (point 1 + 2/4 + 5) of 5-point-likert scales are summarized under results. Results: 573 of 867 questionnaires meeting our criteria were analyzed. In response to a general question 64% (n=358) indicated a wish for disease progression and death and dying to be addressed by their doctor. A majority (76%, n=427) considered it important that progression of their disease be discussed, while 44% (n=246) regard addressing death and dying as unimportant. No objective disease criteria could be identified to explain the wish for communicating end-of-life issues. Doctors who were retrospectively viewed as avoiding raising critical aspects of the illness were perceived as less empathetic (p<0.001). Conclusion: People with MS have a desire to talk about progression of their disease with their doctors. Practice implications: Physicians should be empathetic in raising critical aspects of the patients' illness individually. © 2012 Elsevier Ireland Ltd.

Kloth M.,University of Cologne | Kloth M.,Center for Integrated Oncology Cologne Bonn | Buettner R.,University of Cologne | Buettner R.,Center for Integrated Oncology Cologne Bonn
Genes | Year: 2014

Traditionally, tumors are classified by histopathological criteria, i.e., based on their specific morphological appearances. Consequently, current therapeutic decisions in oncology are strongly influenced by histology rather than underlying molecular or genomic aberrations. The increase of information on molecular changes however, enabled by the Human Genome Project and the International Cancer Genome Consortium as well as the manifold advances in molecular biology and high-throughput sequencing techniques, inaugurated the integration of genomic information into disease classification. Furthermore, in some cases it became evident that former classifications needed major revision and adaption. Such adaptations are often required by understanding the pathogenesis of a disease from a specific molecular alteration, using this molecular driver for targeted and highly effective therapies. Altogether, reclassifications should lead to higher information content of the underlying diagnoses, reflecting their molecular pathogenesis and resulting in optimized and individual therapeutic decisions. The objective of this article is to summarize some particularly important examples of genome-based classification approaches and associated therapeutic concepts. In addition to reviewing disease specific markers, we focus on potentially therapeutic or predictive markers and the relevance of molecular diagnostics in disease monitoring. © 2014 by the authors; licensee MDPI, Basel, Switzerland.

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