Showing papers by "Stefan Schmiedel published in 2019"
TL;DR: This research presents a novel probabilistic procedure called “spot-spot analysis” that allows for real-time analysis of the response of the immune system to foreign substance abuse.
26 citations
TL;DR: No preexisting immunity was detected, however humoral and cell-mediated immunity against internal VSV proteins was observed in up to 36% of vaccines.
Abstract: In response to the Ebola virus (EBOV) crisis of 2013-2016, a recombinant vesicular stomatitis virus (VSV)-based EBOV vaccine was clinically tested (NCT02283099). A single-dose regimen of VSV-EBOV revealed a safe and immunogenic profile and demonstrated clinical efficacy. While EBOV-specific immune responses to this candidate vaccine have previously been investigated, limited human data on immunity to the VSV vector are available. Within the scope of a phase 1 study, we performed a comprehensive longitudinal analysis of adaptive immune responses to internal VSV proteins following VSV-EBOV immunization. While no preexisting immunity to the vector was observed, more than one-third of subjects developed VSV-specific cytotoxic T-lymphocyte responses and antibodies.
25 citations
TL;DR: The notion that immediate initiation of ART with a ritonavir-boosted proteinase-inhibitor and two nucleoside reverse transcriptase inhibitors is safe and has no negative effects on incidence of disease progression or IRIS, nor on immunological and virologic outcomes or on quality of life is supported.
Abstract: To evaluate clinical outcomes after either immediate or deferred initiation of antiretroviral therapy in HIV-1-infected patients, presenting late with pneumocystis pneumonia (PCP) or toxoplasma encephalitis (TE). Phase IV, multicenter, prospective, randomized open-label clinical trial. Patients were randomized into an immediate therapy arm (starting antiretroviral therapy (ART) within 7 days after initiation of OI treatment) versus a deferred arm (starting ART after completing the OI-therapy). All patients were followed for 24 weeks. The rates of clinical progression (death, new or relapsing opportunistic infections (OI) and other grade 4 clinical endpoints) were compared, using a combined primary endpoint. Secondary endpoints were hospitalization rates after completion of OI treatment, incidence of immune reconstitution inflammatory syndrome (IRIS), virologic and immunological outcome, adherence to proteinase-inhibitor based antiretroviral therapy (ART) protocol and quality of life. 61 patients (11 patients suffering TE, 50 with PCP) were enrolled. No differences between the two therapy groups in all examined primary and secondary endpoints could be identified: immunological and virologic outcome was similar in both groups, there was no significant difference in the incidence of IRIS (11 and 10 cases), furthermore 9 events (combined endpoint of death, new/relapsing OI and grade 4 events) occurred in each group. In summary, this study supports the notion that immediate initiation of ART with a ritonavir-boosted proteinase-inhibitor and two nucleoside reverse transcriptase inhibitors is safe and has no negative effects on incidence of disease progression or IRIS, nor on immunological and virologic outcomes or on quality of life.
14 citations
TL;DR: A systematic description of a seasonal influenza patient population at a German university hospital to improve risk stratification and clinical care is described and patients with confirmed influenza infection were included.
Abstract: Es gibt nur wenige strukturierte klinische Erfahrungsberichte zum stationaren Management einer saisonalen Influenzaepidemie. Die systematische Beschreibung eines Patientenkollektivs mit saisonaler Influenza an einem Universitatsklinikum zur Verbesserung von Risikostratifikation und klinischer Versorgung. In der vorliegenden monozentrischen, retrospektiven Observationsstudie der Influenzasaison 2017/2018 am Universitatsklinikum Hamburg-Eppendorf wurden Patienten mit nachgewiesener Influenzainfektion erfasst. 24 % (n = 162/676) der Influenzaabstriche in der Notaufnahme waren positiv. Insgesamt wurde bei 255 Patienten (Median 66 Jahre) eine Influenzainfektion nachgewiesen (Influenza A: n = 79, Influenza B: n = 176); davon waren 27 (15,3 %) nosokomiale Infektionen. 179 (70,2 %) Patienten wurden stationar, davon 51 (20 %) intensivmedizinisch behandelt. Patienten mit Intensivaufenthalt hatten zum Zeitpunkt der Influenzadiagnose einen erhohten CRP-Wert (69,5 mg/dl [SD 62,8] vs. 141,7 [SD 127,2] mg/dl) und haufiger Infiltrate im Rontgen/CT des Thorax (n = 43 [33,6 %] vs. n = 43 [84,3 %]). Eine antivirale Therapie mit Oseltamivir wurde bei 74 (29,0 %) Patienten durchgefuhrt. 11 (6,1 %) Patienten wurden mit extrakorporaler Membranoxygenierung (ECMO) behandelt. 23 (9,0 %) Patienten verstarben. Nur 4 der Verstorbenen waren (trivalent) geimpft und waren mit Influenza B infiziert. Die strukturierte Nutzung von diagnostischen Tests (Influenza-PCR, Rontgen/CT-Thorax und CRP-Wert), antiviraler Therapie (Oseltamivir), gezieltem Management der Aufnahme- bzw. der intensivmedizinischen Kapazitaten sowie die Erhohung der Impfquoten sind wichtig zur Verbesserung der Patientenversorgung und der Ressourcennutzung wahrend saisonaler Grippeepidemien.
14 citations