Biomedical subjects

A Kuhnke

Publications and source records attributed to A Kuhnke.

4 recordsLinked to original sources

PubMed2006

[Pneumonia - pathogen-based or constellation-based therapy?].

Community-acquired pneumonia is one of the most frequent infectious diseases with high morbidity and mortality. Early and sufficient antibiotic treatment is crucial for the prognosis of the patient. The underlying pathogens are mostly unknown at the onset of symptoms. The choice of antibiotic treatment depends on the suspected pathogens, derived from the typical germs and the typical resistances in a certain area. In addition, individual risk factors, such as age, severity of the diseases, comorbidities, and previous antibiotic treatment have a major impact on the probability of dying for an individual patient. These factors must be considered at the beginning of any treatment. Pathogen-based treatment has to be switched to constellation-based treatment.

Anti-Bacterial Agents↗

PubMed2003

[Problems of pharmacotherapy of infections in the aged].

Infectious diseases play an important role in the elderly. Disease progression is often more severe, displaying a higher complication rate and causing increased mortality. Elderly patients suffer more frequently than younger under pneumonia, exacerbations of chronic bronchitis, urinary tract infections as well as skin and soft tissue infections. When starting empiric antibiotic therapy one should consider that the bacterial spectrum afflicting elderly patients may differ from that afflicting younger patients. In addition an increasing number of nosocomial and multiresistant pathogens is seen in elderly patients due to more frequent hospitalisation and living in nursing homes. Patient multimorbidity and multiple co-medications make awareness of important drug-interactions essential. The purpose of this article is to review the indications and side-effects of well-tried and newer antibiotics with respect to patients age. Especially the newer antibiotics Ertapenem, Linezolid, Quinupristin/Dalfopristin and Telithromycin are discussed in detail.

Aged↗

PubMed2003

Bioenergetics of immune cells to assess rheumatic disease activity and efficacy of glucocorticoid treatment.

OBJECTIVE: To investigate whether activity and glucocorticoid treatment of rheumatic diseases are reflected by selected parameters of cellular energy metabolism of peripheral blood mononuclear cells (PBMC). METHODS: PBMC were obtained from 30 healthy volunteers, 28 patients (16 inactive; 12 active) with rheumatoid arthritis, systemic lupus erythematosus, vasculitis, or other autoimmune diseases, and five patients with infectious diseases. Patients with active rheumatic diseases were examined before and 4-5 days after starting, restarting, or increasing the dose of glucocorticoids. Cellular oxygen consumption (as a measure of ATP production), bioenergetic ability to be stimulated, and major ATP consuming processes were measured amperometrically with a Clark electrode. RESULTS: A normal value for oxygen consumption of 3.84 (SEM 0.1) (all data in nmol O(2)/min/10(7) cells) independent of sex was found. In patients with inactive disease the respiration rate was slightly higher, but was significantly increased in active patients to 4.82 (SEM 0.33) (p<0.001). PBMC from active patients showed a significantly lower bioenergetic response to a mitogenic stimulus than controls (p<0.05). In stimulated cells from active patients there was a significant reduction in cation transport and protein synthesis. All parameters above were almost normalised within 4-5 days upon optimised treatment with glucocorticoids. For comparison, PBMC from patients with active infectious diseases also showed an increased respiration rate; their response to mitogenic stimulation was even higher. CONCLUSIONS: This study shows for the first time that parameters describing the cellular function of PBMC in bioenergetic terms are suitable for (a) describing semiquantitatively the activity of a rheumatic disease and (b) assessing the therapeutic effect on the disease.

Adolescent↗

PubMed2000

Bioenergetics of human peripheral blood mononuclear cell metabolism in quiescent, activated, and glucocorticoid-treated states.

The first quantitative findings on the energy metabolism of human immune cells are presented. In quiescent peripheral blood mononuclear cells (PBMC) protein biosynthesis and Na+,K+-ATPase activity each accounted for 8% of cellular oxygen consumption. Stimulation with 25, 50, and 75 microg Con A/ml (1.25, 2.5 or 3.75 microg/10(6) cells) increased total oxygen consumption within seconds by 8, 36, and 53%, respectively. After addition of 75 microg Con A/ml, the proportion of cellular oxygen consumption due to protein biosynthesis, Na+,K+-ATPase activity, and Ca2+-ATPase activity was 15% each and that due to DNA/RNA synthesis was 8%. On the basis of these findings the immediate effects of five different glucocorticoids on cellular energy metabolism were investigated. The various glucocorticoids exerted basically the same inhibitory effects on Con A-stimulated cellular respiration and individual ATP-consuming processes, but differed significantly in potency. Similar to previous studies on rat thymocytes, the relative potencies of the glucocorticoids were found to be: prednylidene (1.7) > dexamethasone (1.5) > methylprednisolone (1.0) > prednisolone (0.3) > betamethasone (< 0.2). Given their rapidity of onset, these effects must be nongenomically mediated. The differences between the relative potencies of the various glucocorticoids for these effects and those for the classical genomic effects have important clinical implications, in particular for high-dose systemic and local glucocorticoid therapy.

Calcium-Transporting ATPases↗