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Hypersensitivity reactions to non‐steroidal anti‐inflammatory drugs (NSAIDs) – a retrospective study
(2020)
Background: The aim of this study was to verify the validity of clinical history and oral provocation challenges of patients with NSAID hypersensitivity and to identify safe alternatives. The COX‐2 inhibitor etoricoxib, in particular, was studied.
Patients and methods: In all, 104 patients with confirmed diagnoses of NSAID hypersensitivity treated at the Department of Dermatology, Frankfurt University Hospital, Germany between 2004 and 2012 were retrospectively studied.
Results: The medical history and hypersensitivity symptoms during oral provocation testing (OPT) largely coincided and were mostly mild to moderate. Acetylsalicylic acid (ASA) was the most frequent trigger both anamnestically (27.9 %) and during OPT (47.8 %). Etoricoxib caused the fewest reactions during OPT (4.2 %). Acetaminophen led to reactions in only 6.7 % of the cases studied although it was named more often in clinical histories (14 %).
Conclusions: OPT should be the aim whenever possible as most symptoms are mild to moderate. To distinguish between selective and cross‐hypersensitivity reactions, ASA should be part of the test protocol. Furthermore, the findings of this study indicate that etoricoxib and acetaminophen are safe treatment alternatives in case of NSAID hypersensitivity. However, these drugs should not be administered without prior OPT in an inpatient setting, as severe symptoms can occur.
Bipolar disorder (BD) is a highly heritable neuropsychiatric disease characterized by recurrent episodes of mania and depression. BD shows substantial clinical and genetic overlap with other psychiatric disorders, in particular schizophrenia (SCZ). The genes underlying this etiological overlap remain largely unknown. A recent SCZ genome wide association study (GWAS) by the Psychiatric Genomics Consortium identified 128 independent genome-wide significant single nucleotide polymorphisms (SNPs). The present study investigated whether these SCZ-associated SNPs also contribute to BD development through the performance of association testing in a large BD GWAS dataset (9747 patients, 14278 controls). After re-imputation and correction for sample overlap, 22 of 107 investigated SCZ SNPs showed nominal association with BD. The number of shared SCZ-BD SNPs was significantly higher than expected (p = 1.46x10-8). This provides further evidence that SCZ-associated loci contribute to the development of BD. Two SNPs remained significant after Bonferroni correction. The most strongly associated SNP was located near TRANK1, which is a reported genome-wide significant risk gene for BD. Pathway analyses for all shared SCZ-BD SNPs revealed 25 nominally enriched gene-sets, which showed partial overlap in terms of the underlying genes. The enriched gene-sets included calcium- and glutamate signaling, neuropathic pain signaling in dorsal horn neurons, and calmodulin binding. The present data provide further insights into shared risk loci and disease-associated pathways for BD and SCZ. This may suggest new research directions for the treatment and prevention of these two major psychiatric disorders.
Mobilität ist eine Grundvoraussetzung, um am gesellschaftlichen Leben teilhaben zu können. Ist der Möglichkeitsraum potenzieller Ortsveränderungen eingeschränkt – beispielsweise durch räumliche, finanzielle oder körperliche Barrieren oder Ängste –, wird von Mobilitätsarmut gesprochen. Wie Mobilitätsarmut auf der Verwaltungsebene verhindert werden kann, zeigt dieser Policy Brief des Projektes Social2Mobility. Diese Handlungsempfehlungen basieren auf Erkenntnissen des Projektes Social2Mobility und adressieren insbesondere Verwaltungsmitarbeitende der Fachplanungen Verkehrs-, Raum- und Sozialplanung von der Kommunal- bis zur Landes- und Bundesebene. Ziel des Projektes Social2Mobility war es, die soziale Teilhabe armutsgefährdeter Personen durch eine Steigerung ihrer Mobilitätsoptionen zu stärken. Der Policy Brief erläutert die Problematik von Mobilitätsarmut, thematisiert deren Relevanz und zeigt verschiedene Facetten von Mobilitätsarmut auf. Er beinhaltet fünf verschiedene Handlungsfelder zur Verhinderung von Mobilitätsarmut. Der Policy Brief soll zu einer dezernats- und abteilungsübergreifenden Zusammenarbeit der Fachplanungen Sozial-, Raum- und Verkehrsplanung zur Lösung von Mobilitätsarmut anregen. Synergieeffekte und gegenseitige Potentiale bei einer Zusammenarbeit werden dabei herausgestellt. Hierzu gehören beispielsweise die Anwendung von Verkehrsnachfragemodellen in der Sozialplanung oder die Berücksichtigung vielfältiger unterschiedlicher Lebenslagen und der daraus hervorgehenden Mobilitätsbedarfe in der Verkehrsplanung.