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  1. Article: Sex-related differences in extracranial complications in patients with traumatic brain injury.

    Brandi, Giovanna / Gambon-Mair, Alma / Berther, Lara Selina / Bögli, Stefan Yu / Unseld, Simone

    Frontiers in neurology

    2023  Volume 14, Page(s) 1095009

    Abstract: Background: Extracranial complications after traumatic brain injury (TBI) are common. Their influence on outcome is uncertain. Furthermore, the role of sex on the development of extracranial complications following TBI remains poorly investigated. We ... ...

    Abstract Background: Extracranial complications after traumatic brain injury (TBI) are common. Their influence on outcome is uncertain. Furthermore, the role of sex on the development of extracranial complications following TBI remains poorly investigated. We aimed to investigate the incidence of extracranial complications after TBI with particular focus on sex-related differences with regard to complications and their influence on outcome.
    Methods: This retrospective, observational study was conducted in a level I universitary swiss trauma center. Consecutive patients with TBI admitted to the intensive care unit (ICU) between 2018 and 2021 were included. Patients' and trauma characteristics, in-hospital complications (i.e., cardiovascular, respiratory, renal, metabolic, gastrointestinal, hematological, and infectious) as well as functional outcome 3 months after trauma were analyzed. Data was dichotomized by sex or by outcome. Univariate as well as multivariate logistic regression was performed to reveal possible associations between sex, outcome and complications.
    Results: Overall, 608 patients were included (male
    Conclusion: Extracranial complications following TBI occur frequently during the ICU-stay, can affect almost all organ systems but are not independent predictors of unfavorable outcome. The results suggest that sex-specific strategies for early recognition of extracranial complications might not be needed in patients with TBI.
    Language English
    Publishing date 2023-04-06
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2564214-5
    ISSN 1664-2295
    ISSN 1664-2295
    DOI 10.3389/fneur.2023.1095009
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Diabetes insipidus and Guillain-Barré-like syndrome following CAR-T cell therapy: a case report.

    Koch, Christian / Fleischer, Juliane / Popov, Todor / Frontzek, Karl / Schreiner, Bettina / Roth, Patrick / Manz, Markus G / Unseld, Simone / Müller, Antonia M S / Russkamp, Norman F

    Journal for immunotherapy of cancer

    2023  Volume 11, Issue 1

    Abstract: Background: Immune effector cell-associated neurotoxicity syndrome (ICANS) is a common adverse event of CD19-directed chimeric antigen receptor (CAR) T cell therapy. Other neurological adverse events, however, have not methodically been described and ... ...

    Abstract Background: Immune effector cell-associated neurotoxicity syndrome (ICANS) is a common adverse event of CD19-directed chimeric antigen receptor (CAR) T cell therapy. Other neurological adverse events, however, have not methodically been described and studied. Furthermore, safety data on CAR-T cell therapy in patients with central nervous system (CNS) lymphoma remain limited.
    Main body: We here report occurrence of a Guillain-Barré-like syndrome (GBS) and central diabetes insipidus (cDI) following tisagenlecleucel therapy for relapsed high-grade lymphoma with CNS involvement. Both complications were refractory to standard treatment of ICANS. Weakness of respiratory muscles required mechanical ventilation and tracheostomy while cDI was treated with desmopressin substitution for several weeks. Muscle-nerve biopsy and nerve conduction studies confirmed an axonal pattern of nerve damage. T cell-rich infiltrates and detection of the CAR transgene in muscle-nerve sections imply a direct or indirect role of CAR-T cell-mediated inflammation. In line with current treatment guidelines for GBS, intravenous immunoglobulin was administered and gradual but incomplete recovery was observed over the course of several months.
    Conclusions: This case report highlights the risk of rare but severe neurological adverse events, such as acute GBS or cDI, in patients treated with CAR-T cells. It further underlines the importance of appropriate patient surveillance and systematic reporting of rare complications to eventually improve treatment.
    MeSH term(s) Humans ; Receptors, Chimeric Antigen ; Immunotherapy, Adoptive/adverse effects ; Lymphoma, Non-Hodgkin ; Central Nervous System Neoplasms ; Diabetes Insipidus/etiology ; Cell- and Tissue-Based Therapy ; Diabetes Mellitus
    Chemical Substances Receptors, Chimeric Antigen ; cell-associated neurotoxicity
    Language English
    Publishing date 2023-01-23
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 2719863-7
    ISSN 2051-1426 ; 2051-1426
    ISSN (online) 2051-1426
    ISSN 2051-1426
    DOI 10.1136/jitc-2022-006059
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Delayed prophylaxis with unfractionated heparin increases the risk of venous thromboembolic events in patients with moderate to severe traumatic brain injury: a retrospective analysis.

    Brandi, Giovanna / Schmidlin, Adrian / Klinzing, Stephanie / Schüpbach, Reto / Unseld, Simone / Pagnamenta, Alberto

    Anaesthesiology intensive therapy

    2020  Volume 52, Issue 1, Page(s) 28–33

    Abstract: Background: Venous thromboembolism (VTE) is a recognized complication in patients with traumatic brain injury (TBI) and is associated with increased morbidity and mortality. Currently, no standard exists for optimal timing or a pharmacological agent for ...

    Abstract Background: Venous thromboembolism (VTE) is a recognized complication in patients with traumatic brain injury (TBI) and is associated with increased morbidity and mortality. Currently, no standard exists for optimal timing or a pharmacological agent for VTE prophylaxis (pharmacological thromboprophylaxis - PTP) in patients with TBI. PTP is often delayed out of fear of causing extension of intracranial hemorrhage (ICH). The purpose of this study was to report the frequency of VTE and ICH progression after initiation of PTP with a continuous infusion of unfractionated heparin in patients with moderate to severe TBI, and to identify risk factors associated with development of VTE.
    Methods: In this single-center retrospective study, patients with moderate to severe TBI admitted to the ICU of a Swiss Level I Trauma Center over a three-year period were analyzed.
    Results: In 23 (13%) of the 177 patients included in the study a VTE episode occurred during the hospital stay. ICH progression after initiation of PTP occurred in 7 (4%) patients. In a multivariable logistic regression model, only the timing of initiation of PTP was identified as an independent predictor of VTE.
    Conclusions: In this study population, the risk of developing VTE increased with the delay of initiation of a pharmacological VTE prophylaxis, while ICH progression after initiation of PTP was a rare event.
    MeSH term(s) Adult ; Aged ; Brain Injuries, Traumatic/complications ; Female ; Heparin/adverse effects ; Heparin/therapeutic use ; Humans ; Intracranial Hemorrhages/etiology ; Male ; Middle Aged ; Retrospective Studies ; Time-to-Treatment ; Venous Thromboembolism/etiology ; Venous Thromboembolism/prevention & control
    Chemical Substances Heparin (9005-49-6)
    Keywords covid19
    Language English
    Publishing date 2020-03-12
    Publishing country Poland
    Document type Journal Article
    ISSN 1731-2531
    ISSN (online) 1731-2531
    DOI 10.5114/ait.2020.93395
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Renal Tubular Acidosis in Pregnant Critically Ill COVID-19 Patients: A Secondary Analysis of a Prospective Cohort.

    Humbel, Simona / Wendel-Garcia, Pedro David / Unseld, Simone / Noll, Fabienne / Schuepbach, Reto Andreas / Ganter, Christoph Camille / Seeger, Harald / David, Sascha / Andermatt, Rea

    Journal of clinical medicine

    2022  Volume 11, Issue 15

    Abstract: Background: Renal tubular acidosis (RTA) is an extremely rare cause of metabolic acidosis (10 in 100,000). RTA has been linked neither to pregnancy nor to severe coronavirus disease 2019 (COVID-19). The purpose of this study was to analyze the ... ...

    Abstract Background: Renal tubular acidosis (RTA) is an extremely rare cause of metabolic acidosis (10 in 100,000). RTA has been linked neither to pregnancy nor to severe coronavirus disease 2019 (COVID-19). The purpose of this study was to analyze the prevalence and clinical course of normal anion gap metabolic acidosis in critically ill pregnant COVID-19 patients and to compare them to an age-matched nonpregnant female patient cohort.
    Methods: Secondary analysis was conducted on a prospective observational cohort of critically ill patients suffering from COVID-19 consecutively admitted to a tertiary intensive care unit (ICU) between February 2020 and April 2021.
    Results: A total of 321 COVID-19 patients required admission to the ICU; 95 (30%) were female, and 18 (19%) were of childbearing age. Seven of eight (88%) pregnant women (all in the last trimester) required advanced respiratory support due to COVID-19. The estimated glomerular filtration rate was 135 (123-158) mL/min/m
    Conclusions: Metabolic acidosis seems to be very common (85%) in pregnant critically ill COVID-19 patients, and the prevalence of RTA might be higher than normal. It remains to be demonstrated if this observation is an indirect epiphenomenon or due to a direct viral effect on the tubular epithelium.
    Language English
    Publishing date 2022-07-22
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm11154273
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: ICU, hospital and one year mortality of patients suffering from solid or haematological malignancies.

    Unseld, Simone / Schuepbach, Reto A / Maggiorini, Marco

    Swiss medical weekly

    2013  Volume 143, Page(s) w13741

    Abstract: Objective: To examine the demographics, evolution and outcome of patients suffering from malignancies admitted to a medical intensive care unit.: Patients and methods: Single centre retrospective cohort study of patients with malignancies. Data on ... ...

    Abstract Objective: To examine the demographics, evolution and outcome of patients suffering from malignancies admitted to a medical intensive care unit.
    Patients and methods: Single centre retrospective cohort study of patients with malignancies. Data on demographics, diagnosis laboratory tests, provided therapy and outcome were retrospectively collected. Data was analysed for differences between patients suffering from solid compared to haematological malignancies as well as for predictors of one year survival.
    Results: A total of 74 consecutive patients with a median age of 62 years were enrolled. From these, 42 (57%) suffered from solid and 32 (43%) from haematological malignancies. In total, 64% of patients with solid malignancies presented with metastatic disease. The main reason for intensive care unit admission in patients with solid malignancies was acute cardiovascular failure (39%) and infections in patients with haematological malignancies (38%). Intensive care unit mortality, hospital mortality and one year mortality were 26%, 35% and 71% overall; 17%, 29% and 69% respectively in patients with solid and 38%, 44% and 73% respectively in patients with haematological malignancies. Survival was close to 40% in patients with no or one organ failure. Survival dropped to 20% with 2 and 13% with ≥3 organs in failure. The number of organs in failure predicted hospital fatality with an AUCRoc of 0.87.
    Conclusion: The number of failing organs rather than malignancy itself drives outcome even in patients with malignancies. Thus the number of organs in failure rather than diagnosis should guide intensive care unit management in patients with malignancies.
    MeSH term(s) Adult ; Aged ; Cohort Studies ; Female ; Hematologic Neoplasms/mortality ; Hospital Mortality ; Humans ; Intensive Care Units/statistics & numerical data ; Male ; Middle Aged ; Multiple Organ Failure/complications ; Multiple Organ Failure/mortality ; Neoplasms/complications ; Neoplasms/mortality ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Switzerland/epidemiology
    Language English
    Publishing date 2013
    Publishing country Switzerland
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2036179-8
    ISSN 1424-3997 ; 1424-7860
    ISSN (online) 1424-3997
    ISSN 1424-7860
    DOI 10.4414/smw.2013.13741
    Database MEDical Literature Analysis and Retrieval System OnLINE

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