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A total of 16 Escherichia coli 06 strains isolated from cases of extraintestinal infections were analysed for the genetic presence and phenotypic expression of fimbrial adhesins ( P, S/FIC, type I), aerobactin and hemolysin. ln addition restriction fragment length polymorphisms (RFLPs) of Xbal-cleaved genomic DNA of seven selected strains, separated by orthogonal field alternation gel electrophoresis {OFAGE) were determined and virulence-associated DNA probes were used for Southern hybridization studies of the Xbal-cleaved genomic DNAs. The virulence characteristics and hybridization patterns obtained differed between the various isolates. ln three isolates hemolysin genes and P fimbrial determinants were located on the same Xbal fragments. Furthermore, multiple copies of FIC determinants (foc) could be detected in two strains. Our data show that the new technique of pulse field electrophoresis tagether with Southern hybridization represents a powerful tool for the genetic analysis of pathogenic bacteria.
Für diese retrospektive Studie wurden die Unterlagen von 490 Patienten, die im Zeitraum von 1990 bis 1999 wegen einer lateralen Mittelgesichtsfraktur in der Universitätsklinik für Hals-, Nasen- und Ohrenkranke in Würzburg operativ versorgt wurden, erfasst und nach verschiedenen Kriterien statistisch ausgewertet. 77,35% der Patienten waren männlich, 22,65% der Patienten weiblich. Der jüngste Verunfallte, der operativ versorgt wurde, war 4 Jahre, die älteste Patientin 87 Jahre alt. Frauen waren in diesem Krankengut um mehr als acht Jahre älter als die Männer. An erster Stelle der Unfallursachen stehen mit annähernd gleicher Anzahl die Verkehrsunfälle(25,51%) und Roheitsdelikte (24,28%), dicht gefolgt von den Unfällen des täglichen Lebens (22,22%) und den Sportunfällen (20,78%). Berufsunfälle sind mit 7,2% nur gering vertreten. Bei den Verkehrsunfällen stehen die PKW-Unfälle mit 58,43%, bei den Sportunfällen die Verletzungen beim Fußballspiel mit 76,4% im Vordergrund. Die häufigste Verletzung in dem untersuchten Zeitraum war die isolierte Orbitabodenfraktur, die zweithäufigste war die Jochbeinfraktur. An dritter Stelle folgte die Kombination aus Orbitaboden- und Orbitarahmenfraktur. Selten war die isolierte Jochbogenfraktur. Die mittlere Zeit bis zur operativen Versorgung nach einer Verletzung betrug 8,05 Tage, welche sich aber bei Visusbeeinträchtigung verlängerte und bei Alkoholkonsum verkürzte. Der häufigste operative Zugang war der subtarsale Zugang, weitere richtetet sich nach der Verletzung. Für die verwendeten Materialien für die Orbitabodenrekonstruktion zeigte sich eine Verschiebung weg von der konservierten Dura, hin zur konservierten Fascia lata und perforierter PDS-Folie.
In dieser Arbeit wurden die Diagnostik- und Behandlungsabläufe von 250 Patienten nach erlittener proximaler Femurfraktur in der Region Würzburg (Deutschland) untersucht. Auswertungsschwerpunkte waren die durchgeführte Diagnostik zur Abklärung einer Osteoporose, die Einleitung einer Pharmakotherapie und die Informationsübermittlung an den weiterbehandelnden Arzt. Aus den erhobenen Daten konnte eine Inzidenz für die Jahre 1993 und 1994 von 180 und eine Inzidenzdichte auf 100.000 Einwohner von 138,5 pro Jahr gemeinsam für Frauen und Männer hochgerechnet werden. Das mittlere Alter der untersuchten Patienten lag bei 76,3 Jahren, die 10%-Perzentile bei 59, die 90%-Perzentile bei 89 Jahren und der Median war 80 Jahre, und damit vergleichbar mit den anderen internationalen Studien. Die geschlechtsspezifischen Verteilung der Frakturen zeigte ein deutliches Übergewicht der Frauen (194 vs. 56 bei Männern). Bei allen Patienten unterblieb eine weitere Abklärung der Frakturursache während des stationären Aufenthaltes, obwohl die Diagnose Osteoporose zumindest hoch wahrscheinlich (241 Fälle) oder stationär festgestellt worden war (147 Fälle, radiologisch oder histologisch). - In keinem Fall wurde die zur Differenzialdiagnose erforderliche Laborroutine vollständig durchgeführt. - In 147 Fällen wurde die Diagnose einer Osteoporose durch den Radiologen (konventionelle Röntgenaufnahme) oder durch den Pathologen (Untersuchung des Femurkopfes) gestellt (in 127 Fällen radiologisch, in 58 Fällen histopathologisch). - Bei nur 20 der so festgestellten 147 Fälle (13,6 %) wurde eine Osteoporose-Therapie stationär eingeleitet und in nur 13 Fällen als Therapieempfehlung für den Entlassungsbericht übernommen. - Wurde die Diagnose durch den Radiologen oder Pathologen gestellt, so unterblieb in 2 von 3 Fällen jegliche Erwähnung im Entlassungsbericht. Wurde sie erwähnt, dann häufig nur in der Form des Röntgen- oder Histologiebefunds. - Die Diagnose Osteoporose wurde in 19,6 % der Entlassungsbriefe übermittelt und lag damit um ca. 5 % höher als der internationale Vergleich. - Wäre die stationär in 147 Fällen bereits festgestellte Diagnose jedes Mal übermittelt worden, hätte sich statt 19,6 % eine Quote von 58,8 % erreichen lassen. Eine Schenkelhalsfraktur steigert die Morbidität und Mortalität der betroffenen Patienten erheblich. Lediglich 23 von zuvor 195 Patienten konnten bei Entlassung aus der Akutklinik ohne Hilfe gehen, während die Zahl der vollständig immobilen Patienten von 2 auf 23 Patienten zum Zeitpunkt der Entlassung zunahm. 14 Patienten (5,6 %) starben im Krankenhaus oder im dokumentierten Beobachtungszeitraum. 26 Patienten (10,4 %) erlitten bereits ihre zweite proximale Femurfraktur, 12 (4,8 %) davon innerhalb nur eines Jahres und zwei sogar ihre dritte proximale Femurfraktur (0,8%). Die für den Patienten wirkungsvollen und das Gesundheitssystem kosteneffektiven Behandlungsmöglichkeiten machen eine weiterführende diagnostische Abklärung und Behandlung der proximalen Femurfraktur aus ethischen und sozioökonomischen Gründen erforderlich. Dies betrifft den Arzt der Akutversorgung und den weiterbehandelnden Arzt gleichermaßen. Die Behandlung sollte multimodal unter Einschluss einer adäquaten Pharmakotherapie erfolgen. Die aktuellen Therapieempfehlungen lassen sich auch für den nicht Osteologen verständlich und praktikabel aus den aktuellen Leitlinien z.B. der Deutschen Gesellschaft für Osteologie entnehmen und anwenden. Zu möglichen nicht medikamentösen Maßnahmen gehören Behandlungskonzepte mit Mobilisationstraining (Fallverhütung), Hüftprotektoren und Reduktion/Vermeidung von Sedativa (v. a. Benzodiazepine). Das Bewusstsein von Ärzten und Patienten muss für den Zusammenhang „Fraktur mit inadäquatem Trauma“ und „Osteoporose“ geschärft werden. Fortbildungen und Öffentlichkeitsarbeit können hier wertvolle Dienste leisten. Jede erlittene Fraktur mit inadäquatem Trauma sollte bei Arzt und Patient die Frage nach einer Osteoporose aufwerfen. Eine weiterführende Abklärung sollte gegebenenfalls eingeleitet und die Notwendigkeit einer Behandlung überprüft werden. - Diese Studie belegt, dass die Versorgung für den untersuchten Zeitraum völlig ungenügend ist. - Sie kann als Basis dienen, um Verbesserungen in diesem Bereich zu dokumentieren. - Sie zeigt, dass umfassende Anstrengungen erforderlich sind, das Bewusstsein für den Zusammenhang proximale Femurfraktur und Osteoporose zu schärfen und effektive Präventionsmaßnahmen (z.B. Verhinderung einer zweiten Schenkelhalsfraktur) einzuleiten.
Invasive Pilzinfektionen haben in den letzten Jahren stetig zugenommen und bedrohen insbesondere immunsupprimierte Patienten. Nach der Zulassung von neuen antimykotisch wirksamen Substanzen hat sich das verfügbare Spektrum an therapeutischen Optionen deutlich erweitert. Demgegenüber steckt die verfügbare Technik zur Resistenztestung humanpathogener Pilze noch weitgehend in den Kinderschuhen. Die Analyse zur Verfügung stehender Techniken ist Gegenstand der vorliegenden Arbeit. Zu diesem Zweck werden zunächst die Daten von 728 klinischen Isolaten von Candida spp., die zwischen April 2000 und November 2002 am Institut für Hygiene und Mikrobiologie der Universität Würzburg unter Anwendung des Mikrodilutionsverfahrens nach DIN getestet wurden, unter epidemiologischen Aspekten ausgewertet. Es zeigt sich ein deutliches Überwiegen von Candida albicans (53%), gefolgt von Candida glabrata (26%). Candida parapsilosis und Candida tropicalis hatten jeweils einen Anteil von ca. 7%. Sowohl Candida albicans wie auch Candida glabrata verhielten sich gegen Fluconazol, Amphotericin B und 5-Flucytosin in hohem Maße sensibel. Candida krusei und Candida tropicalis wurden zu einem nennenswerten Anteil resistent, vor allem gegen Fluconazol und 5-Flucytosin, getestet. Im zweiten Teil der Arbeit wird anhand von 56 Candida spp. ein Vergleich des Mikrodilutionsverfahrens nach DIN und des internationalen Standardverfahrens nach NCCLS durchgeführt. Es zeigen sich sowohl hinsichtlich Reproduzierbarkeit, Ablesezeitpunkt der minimalen Hemmkonzentration sowie Stabilität der Testergebnisse über den angestrebten Ablesezeitpunkt hinaus deutliche Vorteile des NCCLS- gegenüber dem DIN-Verfahren. Der wesentliche Unterschied zwischen beiden Protokollen liegt im verwendeten Wachstumsmedium. Ein Problem beider Verfahren besteht im großen Zeitaufwand, weshalb das YeastOne-Testverfahren, ein kommerziell erhältliches Mikrodilutionsverfahren, das den Farbindikator Alamar Blue zur Erleichterung der visuellen Endpunktbestimmung beinhaltet, im dritten Teil der Arbeit für die Anwendung am Institut in Würzburg gegenüber der NCCLS-Methode evaluiert wird. Es zeigt sich eine hohe Reproduzierbarkeit mit ca. 96% bei Fluconazol, Amphotericin B und 5-Flucytosin und eine gute Korrelation zum Standardverfahren nach NCCLS. Entscheidende Vorteile gegenüber dem NCCLS-Protokoll sind eine frühere Endpunktbestimmung für Azole, die bereits nach 24 Stunden erfolgen kann, sowie in der Zeitersparnis zwischen 64% und 94%. Ergänzend werden einige Schimmelpilze sowohl mit dem NCCLS- als auch mit dem YeastOne-Verfahren getestet, wobei sich eine hohe Korrelation der YeastOne- mit den NCCLS-Ergebnissen zeigt und sich für beide Vorgehensweisen der Ablesezeitpunkt bei gutem Wachstum nach 48 Stunden festlegen lässt. Die Resistenztestung klinischer Isolate wurde daraufhin im Institut für Hygiene und Mikrobiologie auf das YeastOne-System umgestellt. In ersten Anwendungen wurden dabei gute Ergebnisse erzielt.
Bei hohen Inzidenz- und Sterblichkeitsraten ist die Sepsis eine ernstzunehmende Erkrankung mit zugleich ernormer volkswirtschaftlicher Relevanz. Anhand der Vorstellung der Ergebnisse einer Teilnahme an einer europäischen Querschnittstudie zur Sepsis-Epidemiolgie, die 2002 von der ESICM initiiert wurde und an der Intensivstationen ganz Europas teilnahmen, darunter auch die ITS der Chirurgischen Universitätsklinik Würzburg, sollen Schwierigkeiten bei der Erfassung dieses Krankheitsbildes aufgezeigt werden. Es wird die Entwicklung in der Definition des Sepsis-Begriffes diskutiert. Ferner wird das Augenmerk auf die verschiedenen, durch die Sepsis verursachten und dem öffentlichen Gesundheitswesen entstehenden Kosten gelegt und diese werden ihrer Gewichtung nach aufgeführt.
The eradication of infectious agents is an attractive means of disease control that, to date, has been achieved for only one human pathogen, the smallpox virus. The introduction of vaccines against Neisseria meningitidis into immunisation schedules, and particularly the conjugate polysaccharide vaccines which can interrupt transmission, raises the question of whether disease caused by this obligate human bacterium can be controlled, eliminated, or even eradicated. The limited number of meningococcal serogroups, lack of an animal reservoir, and importance of meningococcal disease are considerations in favour of eradication; however, the commensal nature of most infections, the high diversity of meningococcal populations, and the lack of comprehensive vaccines are all factors that suggest that this is not feasible. Indeed, any such attempt might be harmful by perturbing the human microbiome and its interaction with the immune system. On balance, the control and possible elimination of disease caused by particular disease-associated meningococcal genotypes is a more achievable and worthwhile goal.
Das Polyomavirus WU (WUPyV) wurde erstmalig im Jahr 2007 in respiratorischem Material bei Patienten mit respiratorischem Infekt beschrieben. Charakterisierung, Epidemiologie und Beurteilung des Krankheitswerts des neuen Virus sind seither Gegenstand vieler Studien weltweit. Retrospektiv wurde Probenmaterial aus dem Respirationstrakt auf WUPyV mittels PCR untersucht. Das Material war zur virologischen Routinediagnostik eingegangen und stammte von in der Universitätskinderklinik Würzburg stationär behandelten Kindern, deren klinische Diagnosen anonymisiert zur Verfügung standen. Es wurden 1277 Nasenrachensekrete (NRS) berücksichtigt aus dem Zeitraum zwischen Januar 2002 und September 2005 sowie zwischen Januar und Juli 2007. Von 1277 NRS waren 62 (4,9 %) positiv für WUPyV. Das Virus wurde in jedem Monat eines Jahres nachgewiesen, wobei Wintermonate insgesamt stärker vertreten waren. Das mediane Alter der betroffenen Patienten betrug 3,0 Jahre (4 Monate – 6,3 Jahre). Klinische Diagnosen bei WUPyV-Infektionen umfassten ein breites Spektrum an oberen und unteren Luftwegserkrankungen. Bei 33 NRS (53,2 %) waren neben WUPyV zuvor ein oder zwei weitere respiratorische Viren durch PCR oder Immunfluoreszenz-Antigentest nachgewiesen worden (Adenovirus: 10; Influenza A: 10; humanes Bocavirus: 9; RSV: 5; Parainfluenzavirus 1/2/3: 3). Die Sequenzanalyse eines 647 bp langen Abschnitts der nicht kodierenden Region bei 50 WUPyV-positiven NRS zeigte eine Übereinstimmung der Sequenzen von 98,5 %. Die Ergebnisse der vorliegenden Studie unterstützen bisherige Ergebnisse zur Epidemiologie und Verbreitung des WUPyV. Demnach konnte WUPyV-DNA bei akuter respiratorischer Infektion im menschlichen Respirationstrakt, bevorzugt bei Kleinkindern, detektiert werden. WUPyV wies eine hohe Koinfektionsrate mit anderen respiratorischen Viren auf. Es zeigte sich in der phylogenetischen Analyse zweier Genomabschnitte eine geringe Variabilität des Genoms. Bei bisheriger Datenlage bleibt unklar, ob der Nachweis von WUPyV-DNA in NRS mit einer akuten respiratorischen Erkrankung assoziiert werden kann.
Background: Diabetes mellitus type 2 (DM2) is highly associated with increased risk for chronic kidney disease (CKD), end stage renal disease (ESRD) and cardiovascular morbidity. Epidemiological and genetic studies generate hypotheses for innovative strategies in DM2 management by unravelling novel mechanisms of diabetes complications, which is essential for future intervention trials. We have thus initiated the DIAbetes COhoRtE study (DIACORE).
Methods: DIACORE is a prospective cohort study aiming to recruit 6000 patients of self-reported Caucasian ethnicity with prevalent DM2 for at least 10 years of follow-up. Study visits are performed in University-based recruiting clinics in Germany using standard operating procedures. All prevalent DM2 patients in outpatient clinics surrounding the recruiting centers are invited to participate. At baseline and at each 2-year follow-up examination, patients are subjected to a core phenotyping protocol. This includes a standardized online questionnaire and physical examination to determine incident micro-and macrovascular DM2 complications, malignancy and hospitalization, with a primary focus on renal events. Confirmatory outcome information is requested from patient records. Blood samples are obtained for a centrally analyzed standard laboratory panel and for biobanking of aliquots of serum, plasma, urine, mRNA and DNA for future scientific use. A subset of the cohort is subjected to extended phenotyping, e. g. sleep apnea screening, skin autofluorescence measurement, non-mydriatic retinal photography and non-invasive determination of arterial stiffness.
Discussion: DIACORE will enable the prospective evaluation of factors involved in DM2 complication pathogenesis using high-throughput technologies in biosamples and genetic epidemiological studies.
Candida albicans and Candida dubliniensis are pathogenic fungi that are highly related but differ in virulence and in some phenotypic traits. During in vitro growth on certain nutrient-poor media, C. albicans and C. dubliniensis are the only yeast species which are able to produce chlamydospores, large thick-walled cells of unknown function. Interestingly, only C. dubliniensis forms pseudohyphae with abundant chlamydospores when grown on Staib medium, while C. albicans grows exclusively as a budding yeast. In order to further our understanding of chlamydospore development and assembly, we compared the global transcriptional profile of both species during growth in liquid Staib medium by RNA sequencing. We also included a C. albicans mutant in our study which lacks the morphogenetic transcriptional repressor Nrg1. This strain, which is characterized by its constitutive pseudohyphal growth, specifically produces masses of chlamydospores in Staib medium, similar to C. dubliniensis. This comparative approach identified a set of putatively chlamydospore-related genes. Two of the homologous C. albicans and C. dubliniensis genes (CSP1 and CSP2) which were most strongly upregulated during chlamydospore development were analysed in more detail. By use of the green fluorescent protein as a reporter, the encoded putative cell wall related proteins were found to exclusively localize to C. albicans and C. dubliniensis chlamydospores. Our findings uncover the first chlamydospore specific markers in Candida species and provide novel insights in the complex morphogenetic development of these important fungal pathogens.
In this thesis it is shown how the spread of infectious diseases can be described via mathematical models that show the dynamic behavior of epidemics. Ordinary differential equations are used for the modeling process. SIR and SIRS models are distinguished, depending on whether a disease confers immunity to individuals after recovery or not. There are characteristic parameters for each disease like the infection rate or the recovery rate. These parameters indicate how aggressive a disease acts and how long it takes for an individual to recover, respectively. In general the parameters are time-varying and depend on population groups. For this reason, models with multiple subgroups are introduced, and switched systems are used to carry out time-variant parameters.
When investigating such models, the so called disease-free equilibrium is of interest, where no infectives appear within the population. The question is whether there are conditions, under which this equilibrium is stable. Necessary mathematical tools for the stability analysis are presented. The theory of ordinary differential equations, including Lyapunov stability theory, is fundamental. Moreover, convex and nonsmooth analysis, positive systems and differential inclusions are introduced. With these tools, sufficient conditions are given for the disease-free equilibrium of SIS, SIR and SIRS systems to be asymptotically stable.
Background: Dose requirements of erythropoietin-stimulating agents (ESAs) can vary considerably over time and may be associated with cardiovascular outcomes. We aimed to longitudinally assess ESA responsiveness over time and to investigate its association with specific clinical end points in a time-dependent approach. Methods: The German Diabetes and Dialysis study (4D study) included 1,255 diabetic dialysis patients, of whom 1,161 were receiving ESA treatment. In those patients, the erythropoietin resistance index (ERI) was assessed every 6 months during a median follow-up of 4 years. The association between the ERI and cardiovascular end points was analyzed by time-dependent Cox regression analyses with repeated ERI measures. Results: Patients had a mean age of 66 ± 8.2 years; 53% were male. During follow-up, a total of 495 patients died, of whom 136 died of sudden death and 102 of infectious death. The adjusted and time-dependent risk for sudden death was increased by 19% per 5-unit increase in the ERI (hazard ratio, HR = 1.19, 95% confidence interval, CI = 1.07-1.33). Similarly, mortality increased by 25% (HR = 1.25, 95% CI = 1.18-1.32) and infectious death increased by 27% (HR = 1.27, 95% CI = 1.13-1.42). Further analysis revealed that lower 25-hydroxyvitamin D levels were associated with lower ESA responsiveness (p = 0.046). Conclusions: In diabetic dialysis patients, we observed that time-varying erythropoietin resistance is associated with sudden death, infectious complications and all-cause mortality. Low 25-hydroxyvitamin D levels may contribute to a lower ESA responsiveness.
Background
Preterm birth, low birth weight, and infant catch-up growth seem associated with an increased risk of respiratory diseases in later life, but individual studies showed conflicting results.
Objectives
We performed an individual participant data meta-analysis for 147,252 children of 31 birth cohort studies to determine the associations of birth and infant growth characteristics with the risks of preschool wheezing (1-4 years) and school-age asthma (5-10 years).
Methods
First, we performed an adjusted 1-stage random-effect meta-analysis to assess the combined associations of gestational age, birth weight, and infant weight gain with childhood asthma. Second, we performed an adjusted 2-stage random-effect meta-analysis to assess the associations of preterm birth (gestational age <37 weeks) and low birth weight (<2500 g) with childhood asthma outcomes.
Results
Younger gestational age at birth and higher infant weight gain were independently associated with higher risks of preschool wheezing and school-age asthma (P < .05). The inverse associations of birth weight with childhood asthma were explained by gestational age at birth. Compared with term-born children with normal infant weight gain, we observed the highest risks of school-age asthma in children born preterm with high infant weight gain (odds ratio [OR], 4.47; 95% CI, 2.58-7.76). Preterm birth was positively associated with an increased risk of preschool wheezing (pooled odds ratio [pOR], 1.34; 95% CI, 1.25-1.43) and school-age asthma (pOR, 1.40; 95% CI, 1.18-1.67) independent of birth weight. Weaker effect estimates were observed for the associations of low birth weight adjusted for gestational age at birth with preschool wheezing (pOR, 1.10; 95% CI, 1.00-1.21) and school-age asthma (pOR, 1.13; 95% CI, 1.01-1.27).
Conclusion
Younger gestational age at birth and higher infant weight gain were associated with childhood asthma outcomes. The associations of lower birth weight with childhood asthma were largely explained by gestational age at birth."
Background: Population-based data, which continuously monitors time trends in stroke epidemiology are limited. We investigated the incidence of pathological and etiological stroke subtypes over a 16 year time period. Methods: Data were collected within the Erlangen Stroke Project (ESPro), a prospective, population-based stroke register in Germany covering a total study population of 105,164 inhabitants (2010). Etiology of ischemic stroke was classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Results: Between January 1995 and December 2010, 3,243 patients with first-ever stroke were documented. The median age was 75 and 55% were females. The total stroke incidence decreased over the 16 year study period in men (Incidence Rate Ratio 1995-1996 vs. 2009-2010 (IRR) 0.78; 95% CI 0.58-0.90) but not in women. Among stroke subtypes, a decrease in ischemic stroke incidence (IRR 0.73; 95% CI 0.57-0.93) and of large artery atherosclerotic stroke (IRR 0.27; 95% CI 0.12-0.59) was found in men and an increase of stroke due to small artery occlusion in women (IRR 2.33; 95% CI 1.39-3.90). Conclusions: Variations in time trends of pathological and etiological stroke subtypes were found between men and women that might be linked to gender differences in the development of major vascular risk factors in the study population.
Background:
We assessed the diagnostic value of standard clinical methods and combined biomarker testing (galactomannan assay and polymerase chain reaction screening) in a prospective case-control study to detect invasive pulmonary aspergillosis in patients with hematological malignancies and prolonged neutropenia.
Methods:
In this observational study 162 biomarker analyses were performed on samples from 27 febrile neutropenic episodes. Sera were successively screened for galactomannan antigen and for Aspergillus fumigatus specific nucleic acid targets. Furthermore thoracic computed tomography scanning was performed along with bronchoscopy with lavage when clinically indicated. Patients were retrospectively stratified to define a case-group with "proven" or "probable" invasive pulmonary aspergillosis (25.93 %) and a control-group of patients with no evidence for of invasive pulmonary aspergillosis (74.07 %). In 44.44 % of episodes fever ceased in response to antibiotic treatment (group II). Empirical antifungal therapy was administered for episodes with persistent or relapsing fever (group I). 48.15 % of patients died during the study period. Postmortem histology was pursued in 53.85 % of fatalities.
Results:
Concordant negative galactomannan and computed tomography supported by a polymerase chain reaction assay were shown to have the highest discriminatory power to exclude invasive pulmonary aspergillosis. Bronchoalveolar lavage was performed in 6 cases of invasive pulmonary aspergillosis and in 15 controls. Although bronchoalveolar lavage proved negative in 93 % of controls it did not detect IPA in 86 % of the cases. Remarkably post mortem histology convincingly supported the presence of Aspergillus hyphae in lung tissue from a single case which had consecutive positive polymerase chain reaction assay results but was misdiagnosed by both computed tomography and consistently negative galactomannan assay results. For the galactomannan enzyme-immunoassay the diagnostic odds ratio was 15.33 and for the polymerase chain reaction assay it was 28.67. According to Cohen's kappa our in-house polymerase chain reaction method showed a fair agreement with the galactomannan immunoassay. Combined analysis of the results from the Aspergillus galactomannan enzyme immunoassay together with those generated by our polymerase chain reaction assay led to no misdiagnoses in the control group.
Conclusion:
The data from this pilot-study demonstrate that the consideration of standard clinical methods combined with biomarker testing improves the capacity to make early and more accurate diagnostic decisions.
Background and Aims
Chronic kidney disease (CKD) is a risk factor for development and progression of heart failure (HF). CKD and HF share common risk factors, but few data exist on the prevalence, signs and symptoms as well as correlates of HF in populations with CKD of moderate severity. We therefore aimed to examine the prevalence and correlates of HF in the German Chronic Kidney Disease (GCKD) study, a large observational prospective study.
Methods and Results
We analyzed data from 5,015 GCKD patients aged 18-74 years with an estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73m\(^{2}\) or with an eGFR >= 60 and overt proteinuria (>500 mg/d). We evaluated a definition of HF based on the Gothenburg score, a clinical HF score used in epidemiological studies (Gothenburg HF), and self-reported HF. Factors associated with HF were identified using multivariable adjusted logistic regression. The prevalence of Gothenburg HF was 43% (ranging from 24% in those with eGFR >90 to 59% in those with eGFR<30 ml/min/1.73m2). The corresponding estimate for self-reported HF was 18% (range 5%-24%). Lower eGFR was significantly and independently associated with the Gothenburg definition of HF (p-trend <0.001). Additional significantly associated correlates included older age, female gender, higher BMI, hypertension, diabetes mellitus, valvular heart disease, anemia, sleep apnea, and lower educational status.
Conclusions
The burden of self-reported and Gothenburg HF among patients with CKD is high. The proportion of patients who meet the criteria for Gothenburg HF in a European cohort of patients with moderate CKD is more than twice as high as the prevalence of self-reported HF. However, because of the shared signs, symptoms and medications of HF and CKD, the Gothenburg score cannot be used to reliably define HF in CKD patients. Our results emphasize the need for early screening for HF in patients with CKD.
Seasonal Occurrence and Carbapenem Susceptibility of Bovine Acinetobacter baumannii in Germany
(2019)
Acinetobacter baumannii is one of the leading causes of nosocomial infections in humans. To investigate its prevalence, distribution of sequence types (STs), and antimicrobial resistance in cattle, we sampled 422 cattle, including 280 dairy cows, 59 beef cattle, and 83 calves over a 14-month period. Metadata, such as the previous use of antimicrobial agents and feeding, were collected to identify putative determining factors. Bacterial isolates were identified via MALDI-TOF/MS and PCR, antimicrobial susceptibility was evaluated via VITEK2 and antibiotic gradient tests, resistance genes were identified by PCR. Overall, 15.6% of the cattle harbored A. baumannii, predominantly in the nose (60.3% of the A. baumannii isolates). It was more frequent in dairy cows (21.1%) than in beef cattle (6.8%) and calves (2.4%). A seasonal occurrence was shown with a peak between May and August. The rate of occurrence of A. baumannii was correlated with a history of use of 3rd generation cephalosporins in the last 6 months prior to sampling Multilocus sequence typing (Pasteur scheme) revealed 83 STs among 126 unique isolates. Nine of the bovine STs have previously been implicated in human infections. Besides known intrinsic resistance of the species, the isolates did not show additional resistance to the antimicrobial substances tested, including carbapenems. Our data suggest that cattle are not a reservoir for nosocomial A. baumannii but carry a highly diverse population of this species. Nevertheless, some STs seem to be able to colonize both cattle and humans.
Background
The prevalence of food allergy (FA) among European school children is poorly defined. Estimates have commonly been based on parent‐reported symptoms. We aimed to estimate the frequency of FA and sensitization against food allergens in primary school children in eight European countries.
Methods
A follow‐up assessment at age 6‐10 years of a multicentre European birth cohort based was undertaken using an online parental questionnaire, clinical visits including structured interviews and skin prick tests (SPT). Children with suspected FA were scheduled for double‐blind, placebo‐controlled oral food challenges (DBPCFC).
Results
A total of 6105 children participated in this school‐age follow‐up (57.8% of 10 563 recruited at birth). For 982 of 6069 children (16.2%), parents reported adverse reactions after food consumption in the online questionnaire. Of 2288 children with parental face‐to‐face interviews and/or skin prick testing, 238 (10.4%) were eligible for a DBPCFC. Sixty‐three foods were challenge‐tested in 46 children. Twenty food challenges were positive in 17 children, including seven to hazelnut and three to peanut. Another seventy‐one children were estimated to suffer FA among those who were eligible but refused DBPCFC. This yielded prevalence estimates for FA in school age between 1.4% (88 related to all 6105 participants of this follow‐up) and 3.8% (88 related to 2289 with completed eligibility assessment).
Interpretation
In primary school children in eight European countries, the prevalence of FA was lower than expected even though parents of this cohort have become especially aware of allergic reactions to food. There was moderate variation between centres hampering valid regional comparisons.
Introduction/Background
Surfing, wind surfing and kite surfing enjoy a growing popularity with a large number of athletes worldwide. The aim of this study was to identify and compare the injury profiles and compare the injury profiles of these three extreme water sports.
Materials and Methods
These data for this retrospective cohort study were collected through an online standardised questionnaire during the 2017–18 season. The questionnaire included questions about anthropometry, skill level, injury diagnosis, injury mechanism, environmental conditions and training regimes.
Results
The 626 athletes included reported 2584 injuries. On average, each athlete sustained 4.12 injuries during the season. The most frequent injury location was in the lower extremity, in particular the foot, with 49 (16.4%) injuries in surfing, 344 (18.3%) in wind surfing and 79 (19.7%) in kite surfing. Surfing demonstrated a particularly high rate of head injuries (n = 37; 12.4%). Other frequent injury types were skin lesions (up to 42.1%) and contusions (up to 40.5%). The most common injury across all surfing sports was skin lesions of the foot (wind surfing: 11.7%; kite surfing: 13.2%; surfing: 12.7%). In surfing, skin lesions of the head were frequently observed (n = 24; 8.0%). In surfing, a ‘too large wave’ (n = 18; 24.7%) was main cause of the injury, while in wind surfing (n = 189; 34.5%) and kite surfing (n = 65; 36.7%) ‘own incompetence’ led to the most injuries.
Conclusion
This unique study compares injury epidemiology and mechanism in the three most popular surfing sports: wind surfing, kite surfing and surfing. Overall, injuries were sustained mainly in the lower extremity, while surfing also demonstrated a high rate of head injuries.
No studies have carried out an extensive analysis of the possible association between non-syndromic pheochromocytomas and paragangliomas (PPGLs) and other malignancies. To assess >the risk of additional malignancy in PPGL, we retrospectively evaluated 741 patients with PPGLs followed-up in twelve referral centers in Italy. Incidence of second malignant tumors was compared between this cohort and Italian patients with two subsequent malignancies. Among our patients, 95 (12.8%) developed a second malignant tumor, which were mainly prostate, colorectal and lung/bronchial cancers in males, breast cancer, differentiated thyroid cancer and melanoma in females. The standardized incidence ratio was 9.59 (95% CI 5.46–15.71) in males and 13.21 (95% CI 7.52–21.63) in females. At multivariable analysis, the risk of developing a second malignant tumor increased with age at diagnosis (HR 2.50, 95% CI 1.15–5.44, p = 0.021 for 50–59 vs. <50-year category; HR 3.46, 95% CI 1.67–7.15, p < 0.001 for >60- vs. <50-year). In patients with available genetic evaluation, a positive genetic test was inversely associated with the risk of developing a second tumor (HR 0.25, 95% CI 0.10–0.63, p = 0.003). In conclusion, PPGLs patients have higher incidence of additional malignant tumors compared to the general population who had a first malignancy, which could have an impact on the surveillance strategy.
High‐Sensitivity Cardiac Troponin T and Recurrent Vascular Events After First Ischemic Stroke
(2021)
Background
Recent evidence suggests cardiac troponin levels to be a marker of increased vascular risk. We aimed to assess whether levels of high‐sensitivity cardiac troponin T (hs‐cTnT) are associated with recurrent vascular events and death in patients with first‐ever, mild to moderate ischemic stroke.
Methods and Results
We used data from the PROSCIS‐B (Prospective Cohort With Incident Stroke Berlin) study. We computed Cox proportional hazards regression analyses to assess the association between hs‐cTnT levels upon study entry (Roche Elecsys, upper reference limit, 14 ng/L) and the primary outcome (composite of recurrent stroke, myocardial infarction, and all‐cause death). A total of 562 patients were analyzed (mean age, 67 years [SD 13]; 38.6% women; median National Institutes of Health Stroke Scale=2; hs‐cTnT above upper reference limit, 39.2%). During a mean follow‐up of 3 years, the primary outcome occurred in 89 patients (15.8%), including 40 (7.1%) recurrent strokes, 4 (0.7%) myocardial infarctions, and 51 (9.1%) events of all‐cause death. The primary outcome occurred more often in patients with hs‐cTnT above the upper reference limit (27.3% versus 10.2%; adjusted hazard ratio, 2.0; 95% CI, 1.3–3.3), with a dose‐response relationship when the highest and lowest hs‐cTnT quartiles were compared (15.2 versus 1.8 events per 100 person‐years; adjusted hazard ratio, 4.8; 95% CI, 1.9–11.8). This association remained consistent in sensitivity analyses, which included age matching and stratification for sex.
Conclusions
Hs‐cTnT is dose‐dependently associated with an increased risk of recurrent vascular events and death within 3 years after first‐ever, mild to moderate ischemic stroke. These findings support further studies of the utility of hs‐cTnT for individualized risk stratification after stroke.