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Farkas J.,University of Ljubljana | Kosnik M.,University Clinic of Respiratory and Allergic Diseases Golnik | Flezar M.,University Clinic of Respiratory and Allergic Diseases Golnik | Suskovic S.,University Clinic of Respiratory and Allergic Diseases Golnik | Lainscak M.,Charité - Medical University of Berlin
Chest | Year: 2010

Background: Self-rated health predicts outcome in chronic disease, but such information is scarce in COPD. We aimed to assess self-rated health as an outcome predictor in carefully characterized patients with this condition. Methods: This was a prospective study in 127 clinically stable patients with COPD (64 ± 8 years, 79% men, 82% Global Initiative for Chronic Obstructive Lung Disease stage II or III). Self-rated health was assessed using a 5-grade Likert scale ranging from very poor to very good. Results: During 26.0 ± 4.9 months of follow-up, 78 patients experienced acute exacerbation, 39 were hospitalized, and 10 died. Poor or very poor self-rated health was reported by 19 patients (15%) and was more common in patients experiencing acute exacerbations (20% vs 6%, P = .027) and hospitalizations (19% vs 5%, P = .039). Kaplan-Meier curves demonstrated more acute exacerbations ( P = .003) and hospitalizations (P = .008) in patients with poor or very poor self-rated health. In a fully adjusted Cox model of proportional hazard, poor or very poor self-rated health remained predictive of acute exacerbations (hazard ratio [HR], 1.80; 95% CI, 1.03-3.11) and hospitalizations (HR, 1.93; 95% CI, 1.12-3.68) but not of death. Conclusions: This study suggests that self-rated health is predictive of acute exacerbations and hospitalizations. Although prediction of mortality was limited, the study is supportive of self-rated health testing in COPD. © 2010 American College of Chest Physicians.


Knez L.,University Clinic of Respiratory and Allergic Diseases Golnik | Suskovic S.,University Clinic of Respiratory and Allergic Diseases Golnik | Rezonja R.,University of Ljubljana | Laaksonen R.,University of Helsinki | Mrhar A.,University of Ljubljana
Respiratory Medicine | Year: 2011

Poor communication of drug therapy at care interface often results in medication errors and adverse drug events. Medication reconciliation has been introduced as a measure to improve continuity of patient care. The aim of this cross-sectional observational study was to evaluate the need for medication reconciliation. Comprehensive information on pre-admission therapy was obtained by a research pharmacist for adult medical patients, admitted to a teaching hospital, specialised in pulmonary and allergic diseases, in Slovenia. This information was compared with the in-patient and discharge therapies to identify unintentional discrepancies (medication errors) whose clinical significance was determined by an expert panel reaching consensus. Most of the included 101 patients were elderly (median age: 73 years) who had multiple medications. Among their in-patient drugs (880), few discrepancies were a medication error (54/654), half of which were judged to be clinically important. A higher rate was observed in the discharge drug therapy (747): 369 of the identified discrepancies (566) were a medication error, over half of which were judged as clinically important. A greater number of pre-admission drugs, poorly taken medication histories and a greater number of medication errors in in-patient therapy predisposed patients to clinically important medication errors in discharge therapy. This study provided evidence in a small sample of patients on the discontinuity of drug therapy at patient discharge in a hospital in Slovenia and its implications for patient care. To ensure continuity and safety of patient care, medication reconciliation should be implemented throughout a patient's hospital stay. © 2011 Elsevier Ltd. All rights reserved.


Farkas J.,University of Ljubljana | von Haehling S.,Applied Cachexia Research | Kalantar-Zadeh K.,University of California at Irvine | Morley J.E.,Saint Louis University | And 4 more authors.
Journal of Cachexia, Sarcopenia and Muscle | Year: 2013

Perception of healthy body size and composition differs considerably across the globe, ethnic groups, cultures, and even inside medical community. Although the concept of ideal body weight has evolved over the past decades, the observation that weight loss can have more deleterious effects within a short-term period than weight gain has remained rather consistent. Weight loss, as a prelude to cachexia, occurs frequently in a variety of disease states and meets the requirements of a global public health problem. Consequently, interventions to prevent and control chronic diseases require a comprehensive approach that targets a population as a whole and includes both prevention and treatment strategies. Around the globe, cachexia awareness campaigns and expanding the current public health priorities to highlight the cachexia magnitude and areas of interventions is necessary. Simultaneously, scientific efforts should provide us with more reliable estimates of body wasting and cachexia as well as pathophysiology of cachexia-associated death. As certain proportion of patients will, irrespective of preventive measures, eventually develop cachexia, a quest for effective remedy remains vital. © 2013 Springer-Verlag Berlin Heidelberg.


Rozman A.,University Clinic of Respiratory and Allergic Diseases Golnik | Rozman A.,University Clinic of Respiratory and Allergic Diseases | Camlek L.,University Clinic of Respiratory and Allergic Diseases | Marc-Malovrh M.,University Clinic of Respiratory and Allergic Diseases | And 2 more authors.
Respirology | Year: 2013

Background and objective Thoracoscopy with a semi-rigid instrument is a recent technique successfully used for diagnosing pleural diseases. However, there are concerns about the diagnostic adequacy of biopsy samples obtained by semi-rigid procedures when compared with rigid thoracoscopy. The purpose of this study was to compare the size, quality and diagnostic adequacy of biopsy specimens obtained at semi-rigid and rigid thoracoscopy in a prospective, randomized fashion. Methods Patients with pleural effusion of unknown origin and/or pleural irregularities suspicious for pleural malignancy were included after less invasive means of diagnosis had failed. All procedures were performed under local anaesthesia with intravenous sedation/analgesia with a single point of entry. Patients were randomly assigned to a rigid instrument procedure (Olympus EndoEYE WA50120A, forceps) or semi-rigid instrument procedure (Olympus LTF-160, FB-55CR-1 forceps). Results Eighty-four patients were randomized. Five of them were excluded because of lack of pleural space. Thirty-eight patients were assigned to a rigid and 41 to a semi-rigid procedure, with mean follow up 24.1 (±8.1) months after the procedure. The average size of the sample obtained by rigid thoracoscopy was 24.7 mm2 (±12.9), and 11.7 mm2 (±7.6) by semi-rigid thoracoscopy. There were no differences in the quality and interpretability of the specimens assessed by the pathologist. The diagnostic accuracy was 100% for the rigid procedure and 97.6% for the semi-rigid procedure. Conclusions The samples obtained by semi-rigid thoracoscopy were smaller, but of adequate quality. The diagnostic accuracy was comparable with that of rigid thoracoscopy in the evaluation of pleural disease. © 2013 Asian Pacific Society of Respirology.


Lainscak M.,University Clinic of Respiratory and Allergic Diseases Golnik | Lainscak M.,Applied Cachexia Research | Coletta A.P.,University of Hull | Sherwi N.,University of Hull | Cleland J.G.F.,University of Hull
European Journal of Heart Failure | Year: 2010

This article presents findings and a commentary on late-breaking trials presented during the meeting of the Heart Failure Society of America in September 2009. Unpublished reports should be considered as preliminary, since analyses may change in the final publication. The FAST trial showed somewhat better performance of intrathoracic impedance for prediction of deterioration in patients with heart failure (HF) when compared with daily weighing. The IMPROVE-HF study reported the benefits of education on the management of patients with systolic HF. Galectin-3 appeared a useful method for improving risk stratification of patients with chronic HF in a substudy of the COACH trial. A nuclear substudy of the HF-ACTION trial failed to demonstrate that resting myocardial perfusion imaging, a measure of myocardial scar and viability, was clinically useful. A small randomized controlled trial (DAD-HF) suggested that the use of low-dose dopamine in patients with acutely decompensated HF was associated with less deterioration in renal function and less hypokalaemia. The MARVEL-1 trial raises further concerns about the safety of myoblast transplantation in ischaemic HF.


Zidarn M.,University Clinic of Respiratory and Allergic Diseases Golnik | Kosnik M.,University Clinic of Respiratory and Allergic Diseases Golnik | Silar M.,University Clinic of Respiratory and Allergic Diseases Golnik | Bajrovic N.,University Clinic of Respiratory and Allergic Diseases Golnik | Korosec P.,University Clinic of Respiratory and Allergic Diseases Golnik
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2015

Background An important advantage of allergen immunotherapy as compared to pharmacotherapy for allergic rhinitis is the long-term effect that persists after completing immunotherapy. The mechanism of the sustained effect of allergen immunotherapy is not completely understood. Methods We conducted a 7-year study of monitoring allergen-specific basophil response and serological markers in 20 subjects with moderate-to-severe grass pollen-allergic rhinitis just before beginning and after up-dosing of subcutaneous grass pollen immunotherapy, before the first pollen season, and 1-2 years after completion of 3-5 years of treatment. Comparable untreated rhinitis subjects were followed at the same time points. Clinical outcomes included assessment of symptoms, use of rescue medication, and quality of life. The basophil response was also monitored after removal of IgG antibodies. Results Basophil response assessed as area under the curve (AUC) halved during initiation of SCIT and was 55% lower 1-2 years after completing SCIT. In the untreated group, the basophil response remained comparable. Although immunotherapy-induced grass pollen-specific IgG4 levels decreased to near pre-immunotherapy levels after completing SCIT, the removal of IgG antibodies resulted in an increase in basophil response almost to the pre-immunotherapy levels. In untreated subjects, removal of IgG did not have any effect on basophil response. Conclusions Grass pollen immunotherapy induces sustained suppression of the allergen-specific basophil response that persists after completion of treatment and could account for long-term clinical tolerance. It also seems to be associated with persistent blocking activity of IgG antibodies. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


Celesnik Smodis N.,University Clinic of Respiratory and Allergic Diseases Golnik
PloS one | Year: 2014

BACKGROUND: We recently showed a desensitization of FcεRI-mediated basophil response after short-term VIT. Our aim was to evaluate the allergen specificity of this desensitization.METHODS: In 11 Hymenoptera-venom double positive subjects, basophil threshold sensitivity (CD-sens) to anti-FcεRI, honeybee, and Vespula venom was assessed at the beginning and just before the first maintenance dose (MD) of single ultra-rush VIT. In some patients we also monitored CD-sens to rApi m 1 and/or rVes v 5 or other co-sensitizations (i.e., grass pollen). In additional 7 patients, basophils were stripped and sensitized with house dust mite (HDM) IgEs at the same time points.RESULTS: We demonstrated a marked reduction of CD-sens to anti-FcεRI and VIT-specific venom before the first MD in all 18 subjects included. Furthermore, in 10 out of 11 double positive subjects, a significant and comparable decrease before the first MD was also evident for non-VIT venom; this nonspecific decrease was further supported by the opposite recombinant species-specific major allergen. In one subject with additional grass pollen allergy, a decrease of CD-sens to grass allergen was also demonstrated. Similarly, in 7 cases of patients with passively HDM-sensitized basophils, a significant reduction of CD-sens was also evident to de novo sensitized HDM allergen.CONCLUSIONS: Short-term VIT induced basophil desensitization to VIT-specific as well as to VIT-nonspecific venom. As opposed to long-term VIT, which induces venom-specific changes, the effect of short-term VIT seems to be venom-nonspecific.


Triller N.,University Clinic of Respiratory and Allergic Diseases Golnik | Dimitrijevic J.,University Clinic of Respiratory and Allergic Diseases Golnik | Rozman A.,University Clinic of Respiratory and Allergic Diseases Golnik
Respiratory Medicine | Year: 2011

Bronchoscopic lung biopsy using fluoroscopic guidance is the standard procedure for the diagnosis of peripheral pulmonary lesions. Peripheral lesions can also be biopsied using endobronchial ultrasound (EBUS) guidance, which is equally effective and does not expose the patient of staff to radiation. Objectives: We determined the diagnostic yield of EBUS- and fluoroscopic-guided bronchoscopic lung biopsy (BLB) under everyday, clinical conditions, and compared our results to published data. A total of 304 consecutive patients with peripheral pulmonary lesions who underwent EBUS- of fluoroscopy-guided BLB were included in this study. We compared the diagnostic yield of EBUS- and fluoroscopy-guided bronchoscopic lung biopsy (BLB) to determine which method is more sensitive for the diagnosis of peripheral pulmonary lesions. EBUS-guided BLB was performed in 116 patients, and fluoroscopy-guided BLB was used in 188. The median diameter of the peripheral pulmonary lesions in the EBUS group was 31.5 mm (9-125) compared with 34.5 mm (6-100) in the fluoroscopy group. Diagnostic biopsy samples were obtained from 89 (77) patients using EBUS and from 139 (74) patients using fluoroscopy-guided BLB. The difference in the diagnostic outcome between these methods was not statistically significant. The results of our study showed that the diagnostic yield was similar between EBUS- and fluoroscopy-guided BLB, although our findings suggest that more positive outcomes are expected with EBUS. The EBUS procedure is safer because it does not involve exposure of the patient of medical staff to radiation. © 2011 Elsevier Ltd. All rights reserved.


Rijavec M.,University Clinic of Respiratory and Allergic Diseases Golnik | Korosec P.,University Clinic of Respiratory and Allergic Diseases Golnik | Zavbi M.,University Clinic of Respiratory and Allergic Diseases Golnik | Kern I.,University Clinic of Respiratory and Allergic Diseases Golnik | Malovrh M.M.,University Clinic of Respiratory and Allergic Diseases Golnik
Scientific Reports | Year: 2014

Asthma is a chronic inflammatory disease. Around 5 to 10% of patients classified as having severe asthma can-not be adequately controlled despite the use of all currently available therapeutic approaches. Previous studies have revealed the potential important role of miRNAs in the regulation of a variety of inflammatory processes, including asthma. Expression of selected miRNAs, specifically let-7a, miR-21 and miR-223, that were shown to have important roles in asthma pathogenesis, were analyzed in bronchial biopsies of 24 patients with asthma, 12 mild and 12 severe, and 10 controls with no chronic disease. We found significantly reduced expression of let-7a in bronchial biopsies from patients with severe asthma in comparison to patients with mild asthma as well as in comparison to the non-asthmatic controls. On the other hand, no significant differences in miR-21 and miR-223 expression were found between the different groups analyzed. Reduced let-7a levels in bronchial biopsies of patients with severe therapy-resistant asthma could not only be used as a potential biomarker to discriminate between different asthma phenotypes, but also might be a target for modulation of treatment at the inflammatory site for a group of patients that are most affected and still lack effective treatment.


Patent
University Clinic Of Respiratory And Allergic Diseases Golnik | Date: 2013-11-13

The present invention relates to methods and materials for the diagnosis of anaphylaxis, and more particularly to the role of basophil absolute count and the expression of the high affinity IgE in the occurrence of anaphylaxis. Methods of diagnosing anaphylaxis by determining the absolute number of basophils in whole blood or by determining the expression of the chain of high affinity IgE receptor in whole blood are disclosed.

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