Individual risk assessment of adverse pregnancy outcome by multivariate regression analysis may serve as basis for drug intervention studies: retrospective analysis of 426 high-risk patients including ethical aspects

OBJECTIVE: To identify patients at very high risk for adverse pregnancy outcome (APO) at the 20- to 23-week scan and to assess the effectiveness of Aspirin (ASS) and low molecular weight heparin (LMWH) starting after this examination. PATIENTS AND METHODS: By applying an algorithm based on multivariate logistic regression analysis using the parameters maternal age, parity, body mass index (BMI), mean pulsatility index of both uterine arteries (meanPI), presence of uni- or bilateral notch, and depth of notch (mean notch index (meanNI), we retrospectively calculated the individual risk for APO of 21,302 singleton pregnancies. We isolated a subgroup of 426 patients with the highest calculated probability for APO (cpAPO > 27.8 %). 147 had been treated with ASS; 73 with LMWH, 15 patients with a combination of ASS and LMWH, and 191 patients had not received anticoagulants. RESULTS: Administration of ASS starting after 20 gestational weeks in comparison to non-treated patients significantly reduced the frequency of intrauterine/neonatal death (IUD/NND), preeclampsia <33 weeks (PE < 33), and preterm delivery <33 weeks (PD < 33), while the frequency of IUGR showed a tendency to be elevated (P = 0.061). The subgroup of high-risk patients treated with LMWH was characterised by a higher a priori risk for APO and showed no significant reduction of any form of APO but an increased frequency of PE. CONCLUSION: Individual assessment of risk for APO by applying a simple algorithm based on biometrical/biographical as well as sonographic parameters may serve as basis for drug intervention studies. The administration of ASS in high-risk patients starting after 20 gestational weeks reduced the frequency of most of the severe forms of adverse pregnancy outcome in high-risk patients. A complication-reducing effect of LMWH starting after 20 weeks of gestation in patients could not be proven. From an ethical point of view, it may not be justified any more to preclude high-risk patients from administration of ASS or to perform studies of ASS against placebo

Gesundheit - Markt - Gerechtigkeit

"The three elements of the title intersect at three points which will be discussed from the perspective of three professions – medicine, economics, and ethics. The discussion of the nine emerging topics illustrates the chances and risks in this field of conflicting principles. As cryptonormative definitions are one of the most frequent sources of error, we try to be as transparent as possible in the use of different terms and thus to come to resilient conclusions." (author's abstract

Multiple Sklerose Therapie Konsensus Gruppe (MSTKG): Positionspapier zur verlaufsmodifizierenden Therapie der Multiplen Sklerose 2021 (White Paper)

Multiple sclerosis is a complex, autoimmune-mediated disease of the central nervous system characterized by inflammatory demyelination and axonal/neuronal damage. The approval of various disease-modifying therapies and our increased understanding of disease mechanisms and evolution in recent years have significantly changed the prognosis and course of the disease. This update of the Multiple Sclerosis Therapy Consensus Group treatment recommendation focuses on the most important recommendations for disease-modifying therapies of multiple sclerosis in 2021. Our recommendations are based on current scientific evidence and apply to those medications approved in wide parts of Europe, particularly German-speaking countries (Germany, Austria, Switzerland)

Diskurse über induzierte pluripotente Stammzellforschung und ihre Auswirkungen auf die Gestaltung sozialkompatibler Lösungen – eine interdisziplinäre Bestandsaufnahme

Abstract Die Herstellung induzierter pluripotenter Stammzellen (iPS-Zellen) hat wahre Begeisterungsstürme in der Biomedizin, ihren bereichsethischen Reflexionen sowie der sie begleitenden Medienberichterstattung ausgelöst. Die Forschung an und (potentielle) klinische Nutzung von iPS-Zellen versprechen, ethische Kontroversen zu umgehen, welche durch die verbrauchende Forschung an humanen embryonalen Stammzellen (hES-Zellen) aufgeworfen und in Bioethik, Sozial- und Rechtswissenschaft sowie der bundesdeutschen Öffentlichkeit problematisiert worden waren. Die Induzierung pluripotenter Stammzellen macht jedoch nicht nur Hoffnung auf Heilung von Krankheiten, neue reproduktionsmedizinische Möglichkeiten und andere innovative biomedizinische Verfahren, sondern birgt erneut Unsicherheiten und wirft teilweise noch unbekannte Risiken auf, mit denen sich insbesondere die rechtliche Beurteilung und Gesetzgebung konfrontiert sehen. Dieser Beitrag versammelt Betrachtungen aus ethischer, politikwissenschaftlicher und juristischer Perspektive, um einem transparenten Umgang mit der Regulierung der iPS-Zellforschung und ihren Anwendungen den Weg zu ebnen. Sollen sozialkompatible und demokratisch erzeugte legitime Lösungen für den Einsatz von iPS-Zellen in Medizin und Forschung gefunden werden, so muss die ethische Legitimität des Einsatzes, ihr rechtlicher Status und die diesbezüglichen gesellschaftlichen Erwartungen untersucht und in politische Entscheidungsprozesse miteinbezogen werden.</jats:p

Influence of air pressure, humidity, solar radiation, temperature, and wind speed on ambulatory visits due to chronic obstructive pulmonary disease in Bavaria, Germany

Chronic obstructive pulmonary disease (COPD) is one of the most important causes of morbidity and mortality in the world. The disease is often aggravated by periods of increased symptoms requiring medical attention. Among the possible triggers for these exacerbations, meteorological factors are under consideration. The objective of this study was to assess the influence of various meteorological factors on the health status of patients with COPD. For this purpose, the daily number of ambulatory care visits due to COPD was analysed in Bavaria, Germany, for the years 2006 and 2007. The meteorological factors were provided by the model at the European Centre for Medium Range Weather Forecast (ECMWF). For the multivariate analysis, a generalised linear model was used. In Bavaria, an increase of 1% of daily consultations (about 103 visits per day) was found to be associated with a change of 0.72 K temperature, 209.55 of log surface pressure in Pa, and a decrease of 1% of daily consultations with 1,453,763 Ws m 2 of solar radiation. There also seem to be regional differences between north and south Bavaria; for instance, the effect of wind speed and specific humidity with a lag of 1 day were only significant in the north. This study could contribute to a tool for the prevention of exacerbations. It also serves as a model for the further evaluation of the impact of meteorological factors on health, and could easily be applied to other diseases or other regions