Unusual presentation of fatal disseminated varicella zoster virus infection in a patient with lupus nephritis: A case report

Background: The risk of life-threatening complications, such as visceral disseminated varicella zoster virus (VZV) infection, is greater in immunosuppressed individuals, such as systemic lupus erythematosus (SLE) patients. Case presentation: Here, a case is reported of a Caucasian woman diagnosed with lupus nephritis and anti-phospholipid syndrome, who was subjected to mycophenolate mofetil and high-dose steroid remission-induction therapy. Two months later she developed abdominal pain followed by a fatal rapid multi-organ failure. As no typical skin rashes were evident, death was initially attributed to catastrophic anti-phospholipid syndrome. However, autopsy and virological examinations on archival material revealed a disseminated VZV infection. Conclusions: Overall, this case highlights the importance of having a high clinical suspicion of fatal VZV infections in heavily immunosuppressed SLE patients even when typical signs and symptoms are lacking

Study satisfaction among university students during the COVID-19 pandemic: longitudinal development and personal-contextual predictors

The COVID-19 pandemic challenges the well-being and academic success of many students. Yet, little is known about students’ study satisfaction during the COVID-19 pandemic, a multilayered construct which accounts for students’ subjective cognitive well-being and academic success. Besides, previous studies on study satisfaction are mostly cross-sectional and hardly consider the distinct subdimensions of this construct. Therefore, our main goal in this study was to shed light on the understudied development of the subdimensions of study satisfaction (i.e., satisfaction with study content, conditions of studying, and coping with study-related stress) in two semesters amid the COVID-19 pandemic. Additionally, we examined how particular personal (i.e., gender, age, GPA, intrinsic motivation, motivational cost, and academic procrastination) and contextual (i.e., loneliness) factors are related to these subdimensions. We conducted two panel studies with convenience and purposeful samples of university students in Germany (Nstudy1 = 837; Nstudy2 = 719). Participants responded online to questions on each of the subdimensions of study satisfaction at the beginning, middle, and end of each semester but responded to measures of personal and contextual factors only at the beginning of each semester. In both studies, manifest growth curve models indicated a decrease in all subdimensions of study satisfaction as the semester progressed. Generally, gender (male) and intrinsic motivation were positive predictors but age (younger students), motivational cost, and loneliness were negative predictors of different subdimensions of study satisfaction – particularly satisfaction with study content. Overall, motivational costs and loneliness were the most consistent predictors of all subdimensions of study satisfaction across both studies. Our findings provide support for the understanding that study satisfaction could diminish in the face of challenging situations such as in this pandemic. The present study also highlights certain personal and contextual factors that relate to study satisfaction and calls for intensive research into the multidimensional construct of study satisfaction

Major Depressive Disorder (MDD) and Antidepressant Medication Are Overrepresented in High-Dose Statin Treatment

Objective: To examine the dose-dependent relationship of different types of statins with the occurrence of major depressive disorder (MDD) and prescription of antidepressant medication. Methods: This cross-sectional study used medical claims data for the general Austrian population (n = 7,481,168) to identify all statin-treated patients. We analyzed all patients with MDD undergoing statin treatment and calculated the average defined daily dose for six different types of statins. In a sub-analysis conducted independently of inpatient care, we investigated all patients on antidepressant medication (statin-treated patients: n = 98,913; non-statin-treated patients: n = 789,683). Multivariate logistic regression analyses were conducted to calculate the risk of diagnosed MDD and prescription of antidepressant medication in patients treated with different types of statins and dosages compared to non-statin-treated patients. Results: In this study, there was an overrepresentation of MDD in statin-treated patients when compared to non-statin-treated patients (OR: 1.22, 95% CI: 1.20–1.25). However, there was a dose dependent relationship between statins and diagnosis of MDD. Compared to controls, the ORs of MDD were lower for low-dose statin-treated patients (simvastatin>0– 0– 0– 40– 60–80 mg:OR: 5.27, 95% CI: 4.21–6.60; atorvastatin>40– 60– 20– < =40 mg:OR: 2.09, 95% CI: 1.31–3.34). The results were confirmed in a sex-specific analysis and in a cohort of patients taking antidepressants, prescribed independently of inpatient care. Conclusions: This study shows that it is important to carefully re-investigate the relationship between statins and MDD. High-dose statin treatment was related to an overrepresentation, low-dose statin treatment to an underrepresentation of MDD

Betatrophin is downregulated in pregnant women with a history of RYGB operation and a high risk of postprandial hypoglycaemia

Betatrophin is a liver and adipose tissue-derived protein which has recently been linked to glucose metabolism. So far, no data exist about the role of betatrophin in pregnant women with a history of Roux-En-Y gastric bypass (RYGB) operation with a high risk of postprandial hypoglycaemia. In this prospective clinical study, an oral glucose tolerance test (OGTT) and an intravenous glucose tolerance test (IVGTT) were performed between the 24th and 28th week of pregnancy and 3-6 months post-partum in a cohort of obese and normal-weight pregnant women, as well as in women with a history of RYGB operation. In the cohort of pregnant women with RYGB and exaggerated risk of postprandial hypoglycaemic events, basal and dynamic betatrophin levels during the OGTT were lower than in the obese or normal-weight pregnant women (basal levels: 13.66 ± 5.88 vs. 19.03 ± 4.15 vs. 15.68 ± 6.48, p = 0.016; OGTT 60': 13.33 ± 5.40 vs. 17.37 ± 3.16 vs. 15.84 ± 4.99, p = 0.030). During the OGTT, basal and dynamic betatrophin levels at 60' were positively associated with glucose levels at 60 min (r = 0.55, p = 0.01 and r = 0.45, p = 0.039). This positive association was followed by significant hypoglycaemic events in the RYGB group. It was only in the RYGB group that betatrophin was negatively related to the disposition index (rho = -0.53, p = 0.014). After pregnancy there was a decrease in basal and stimulated betatrophin levels during the OGTT in all three patient groups. In comparison to normal-weight and obese pregnant women, women with a history of RYGB operation and a high risk of postprandial hypoglycaemic events have lower levels of betatrophin. This indicate a mechanistic role in order to decrease the risk of postprandial hypoglycaemia in this specific cohort

Diagnosis of osteoporosis in statin-treated patients is dose-dependent

Objective Whether HMG-CoA-reductase inhibition, the main mechanism of statins, plays a role in the pathogenesis of osteoporosis, is not entirely known so far. Consequently, this study was set out to investigate the relationship of different kinds and dosages of statins with osteoporosis, hypothesising that the inhibition of the synthesis of cholesterol could influence sex-hormones and therefore the diagnosis of osteoporosis. Methods Medical claims data of all Austrians from 2006 to 2007 was used to identify all patients treated with statins to compute their daily defined dose averages of six different types of statins. We applied multiple logistic regression to analyse the dose-dependent risks of being diagnosed with osteoporosis for each statin individually. Results In the general study population, statin treatment was associated with an overrepresentation of diagnosed osteoporosis compared with controls (OR: 3.62, 95% CI 3.55 to 3.69, p<0.01). There was a highly non-trivial dependence of statin dosage with the ORs of osteoporosis. Osteoporosis was underrepresented in low-dose statin treatment (0–10 mg per day), including lovastatin (OR: 0.39, CI 0.18 to 0.84, p<0.05), pravastatin (OR: 0.68, 95% CI 0.52 to 0.89, p<0.01), simvastatin (OR: 0.70, 95% CI 0.56 to 0.86, p<0.01) and rosuvastatin (OR: 0.69, 95% CI 0.55 to 0.87, p<0.01). However, the exceeding of the 40 mg threshold for simvastatin (OR: 1.64, 95% CI 1.31 to 2.07, p<0.01), and the exceeding of a 20 mg threshold for atorvastatin (OR: 1.78, 95% CI 1.41 to 2.23, p<0.01) and for rosuvastatin (OR: 2.04, 95% CI 1.31 to 3.18, p<0.01) was related to an overrepresentation of osteoporosis. Conclusion Our results show that the diagnosis of osteoporosis in statin-treated patients is dose-dependent. Thus, osteoporosis is underrepresented in low-dose and overrepresented in high-dose statin treatment, demonstrating the importance of future studies’ taking dose-dependency into account when investigating the relationship between statins and osteoporosis

Increase in testosterone levels is related to a lower risk of conversion of prediabetes to manifest diabetes in prediabetic males

Background: Testosterone plays an important role in the regulation of glucose metabolism. While earlier studies have shown that it has a protective effect in males, unfavorable effects of testosterone on glucose metabolism have been reported in females; however, whether there is a sex-specific relationship between testosterone and glucose metabolism in patients with prediabetes has not been investigated in detail hitherto. Methods: This cross-sectional analysis investigated 423 males and 287 females with diagnosed prediabetes. Detailed assessment of their metabolic profiles was performed, including a 2‑h oral glucose tolerance test (OGTT), HbA1c levels, calculation of insulin resistance with homeostatic model assessment for insulin resistance (HOMA-IR), assessment of lipid metabolism, anthropometric parameters and the fatty liver index (FLI). By using Spearman's correlation test, we investigated the sex-specific relationship between testosterone and metabolism in the prediabetic individuals. Results: In the present study, prediabetic females (mean age 58.6 years, confidence interval [CI: 57.6 y; 59.5 y]) were characterized by lower fasting plasma glucose levels (104.2 mg/dl [CI: 103.0 mg/dl; 105.4 mg/dl] vs. 106.9 mg/dl [CI: 106.0 mg/dl; 107.8 mg/dl]) and a lower FLI (49.5 [CI: 45.7; 53.2] vs. 58.8 [CI: 55.8; 61.8]), but presented with a higher risk of developing manifest type 2 diabetes in the next 10 years (FINDRISK score: 17.6 [CI: 17.1; 18.1] vs. 16.1 [CI: 15.7; 16.5]) when compared to prediabetic males (mean age: 58.04 years [CI: 57.0 y; 59.1 y]). Testosterone was negatively related to insulin resistance (HOMA-IR: Spearman's ρ: -0.33, p < 0.01), 2‑h stimulated glucose levels during the OGTT (ρ = -0.18, p < 0.01), HbA1c levels (ρ = -0.13, p < 0.05), FLI and BMI in prediabetic males; however, no relationship between testosterone and metabolic parameters could be found in prediabetic females. Conclusion: The increase of testosterone levels in males was related to a more favorable glucose metabolism, including lower HbA1c, lower stimulated glucose levels and higher insulin sensitivity; however, in prediabetic females, testosterone was not related to glucose metabolism

Systematic population-wide ecological analysis of regional variability in disease prevalence

The prevalence of diseases often varies substantially from region to region. Besides basic demographic properties, the factors that drive the variability of each prevalence are to a large extent unknown. Here we show how regional prevalence variations in 115 different diseases relate to demographic, socio-economic, environmental factors and migratory background, as well as access to different types of health services such as primary, specialized and hospital healthcare. We have collected regional data for these risk factors at different levels of resolution; from large regions of care (Versorgungsregion) down to a 250 by 250 m square grid. Using multivariate regression analysis, we quantify the explanatory power of each independent variable in relation to the regional variation of the disease prevalence. We find that for certain diseases, such as acute heart conditions, diseases of the inner ear, mental and behavioral disorders due to substance abuse, up to 80% of the variance can be explained with these risk factors. For other diagnostic blocks, such as blood related diseases, injuries and poisoning however, the explanatory power is close to zero. We find that the time needed to travel from the inhabited center to the relevant hospital ward often contributes significantly to the disease risk, in particular for diabetes mellitus. Our results show that variations in disease burden across different regions can for many diseases be related to variations in demographic and socio-economic factors. Furthermore, our results highlight the relative importance of access to health care facilities in the treatment of chronic diseases like diabetes

Different motivational profiles of university students and their relation to demographic characteristics, learning behavior, and study-related well-being

Auf der Basis eines multidimensionalen Verständnisses von Studienmotivation wird ein Zusammenspiel motivationaler Variablen verschiedener Phasen des Studiums im Hinblick auf akademische Erfolgskriterien angenommen. Jedoch gibt es hierzu bislang keine empirische Evidenz. In der vorliegenden Studie wurde das Ziel verfolgt, das intraindividuelle Zusammenspiel intrinsischer und extrinsischer Studienwahlmotivation als Variablen der Studienvorphase sowie des akademischen Selbstkonzepts und der akademischen Selbstwirksamkeit als Variablen der Phase im Studium in Form motivationaler Profile von Studierenden aufzudecken. Ferner wurden Unterschiede zwischen Studierenden verschiedener motivationaler Profile hinsichtlich demografischer Merkmale, Bildungsmerkmalen, Lernverhalten (Anstrengung und Prokrastination) und Befinden (Studienzufriedenheit, Studienabbruchintention) ermittelt. An der Studie nahmen N = 1,426 Studierende der Studienbereiche MINT, Rechtswissenschaft, Wirtschaftswissenschaft und Erziehungswissenschaft teil. Mittels der Analyse latenter Profile wurden fünf motivationale Profile ermittelt. Männliche Studierende, jüngere Studierende und Studierende jüngerer Semester waren in Profilen mit höheren Ausprägungen der motivationalen Variablen stärker vertreten. Insgesamt wiesen Studierende in Profilen mit höherer im Vergleich zu moderater Studienmotivation ein günstigeres Studierverhalten und geringere Studienabbruchintentionen auf. Der Beitrag stützt die Relevanz, die motivationalen Prozessen für günstiges Lernverhalten und Studienabbruch zugeschrieben wird. Auch wenn ein Großteil der Studierenden in diesem Beitrag eine hohe Studienmotivation berichtete, legen die Befunde nahe, Maßnahmen zur Förderung von Studienmotivation für Subgruppen von Studierenden in der Hochschulpraxis anzubieten. (DIPF/Orig.)On the basis of a multidimensional understanding of study motivation, an interplay of motivational variables of different study phases with regard to academic success is assumed. Yet, it lacks empirical evidence regarding this interplay. The aim of the present study was to uncover the intraindividual interplay of intrinsic and extrinsic study choice motivation representing variables of the pre-university phase and of academic self-concept and academic self-efficacy indexing variables of the study phase as combined in motivational profiles. Furthermore, we identified differences between students of the distinct motivational profiles with respect to demographic characteristics, educational characteristics, learning behavior (effort and procrastination), and well-being (study satisfaction, student dropout intention). The sample consisted of N = 1,426 students, enrolled in STEM, law, economics and educational science majors. Applying latent profile analysis, we identified five motivational profiles. Profiles expressing higher motivation were disproportionate for male students, younger students, and students of lower semesters. Overall, students in profiles with high compared to moderate study motivation showed more adaptive study behavior and lower student dropout intentions. The present study underlines the relevance attributed to motivational processes for adaptive learning behavior and student dropout intention. Although a large proportion of students reported high study motivation, our findings suggest that approaches to foster student motivation should be offered in higher education and address specific groups of students. (DIPF/Orig.

Impact Factor: outdated artefact or stepping-stone to journal certification?

A review of Garfield's journal impact factor and its specific implementation as the Thomson Reuters Impact Factor reveals several weaknesses in this commonly-used indicator of journal standing. Key limitations include the mismatch between citing and cited documents, the deceptive display of three decimals that belies the real precision, and the absence of confidence intervals. These are minor issues that are easily amended and should be corrected, but more substantive improvements are needed. There are indications that the scientific community seeks and needs better certification of journal procedures to improve the quality of published science. Comprehensive certification of editorial and review procedures could help ensure adequate procedures to detect duplicate and fraudulent submissions.Comment: 25 pages, 12 figures, 6 table

Automated protein resonance assignments of magic angle spinning solid-state NMR spectra of β1 immunoglobulin binding domain of protein G (GB1)

Magic-angle spinning solid-state NMR (MAS SSNMR) represents a fast developing experimental technique with great potential to provide structural and dynamics information for proteins not amenable to other methods. However, few automated analysis tools are currently available for MAS SSNMR. We present a methodology for automating protein resonance assignments of MAS SSNMR spectral data and its application to experimental peak lists of the β1 immunoglobulin binding domain of protein G (GB1) derived from a uniformly 13C- and 15N-labeled sample. This application to the 56 amino acid GB1 produced an overall 84.1% assignment of the N, CO, CA, and CB resonances with no errors using peak lists from NCACX 3D, CANcoCA 3D, and CANCOCX 4D experiments. This proof of concept demonstrates the tractability of this problem