Lymphogranuloma venereum: Eine alte Krankheit in neuem Kleid

Zusammenfassung: Lymphogranuloma venereum ist eine sexuell übertragene Erkrankung verursacht durch Chlamydia trachomatis der Serotypen L1, L2 und L3. Die klassische Manifestation ist eine schmerzhafte inguinale Lymphadenopathie, welche ohne Behandlung zu schwerwiegenden Komplikationen führt. Daneben wird seit einigen Jahren gehäuft eine ulzerierende Proktitis beschrieben, speziell bei Männern, die Sex mit Männern haben. Da die klinischen Beschwerden unspezifisch sind, muss bei Proktitis aktiv nach Chlamydia trachomatis gesucht werden. Die Diagnostik des Lymphogranuloma venereum erfolgt heute hauptsächlich mit molekularen Testverfahren. Zur Therapie wird Tetracyclin über 3Wochen empfohlen. Die Erkrankung wird anhand von 5 aktuellen klinischen Fallbeispielen dargestell

Secular Trend and Risk Factors for Antimicrobial Resistance in Escherichia coli Isolates in Switzerland 1997-2007

Abstract : Background: : Antibacterial resistance in Escherichia coli isolates of urinary infections, mainly to fluoroquinolones, is emerging. The aim of our study was to identify the secular trend of resistant E. coli isolates and to characterize the population at risk for colonization or infections with these organisms. Patients and Methods: : Retrospective analysis of 3,430 E.coli first isolates of urine specimens from patients admitted to the University Hospital Basel in 1997, 2000, 2003, and 2007. Results: : Resistance to ciprofloxacin, trimethoprim/sulfamethoxazole, and amoxicillin/clavulanate has increased over the 10-year study period (from 1.8% to 15.9%, 17.4% to 21.3%, and 9.5% to 14.5%, respectively). A detailed analysis of the 2007 data revealed that independent risk factors for ciprofloxacin resistance were age (5.3% 75 years; odds ratio [OR] 1.29 per 10 years, 95% confidence interval [CI] 1.15-1.45, p < 0.001) and male gender (OR 1.59, 95% CI 1.05-2.41, p = 0.04). In contrast, nosocomial E. coli isolates were associated with lower odds of ciprofloxacin resistance (OR 0.51, 95% CI 0.28-0.67, p < 0.001). The frequency of resistant isolate rates was not influenced by the clinical significance (i.e., colonization vs urinary tract infection, UTI) or by whether the urine was taken from a urinary catheter. Importantly, the increase in ciprofloxacin resistance paralleled the increase in ciprofloxacin consumption in Switzerland (Pearson's correlation test R2= 0.998, p = 0.002). Of note, resistance was less frequent in isolates sent in by general practitioners. However, after adjustment for age and gender, only resistance against amoxicillin/clavulanate was found to be less frequent (OR 0.34, 95% CI 0.16-0.92, p = 0.03). Conclusion: : Our study reveals that resistance rates have been increasing during the last decade. Published resistance rates may lack information due to important differences regarding age, gender, and probable origin of the isolates. Empirical therapy for UTI should be guided more on individual risk profile and local resistance data than on resistance data bank

Validation of modelling the radiation exposure due to solar particle events at aircraft altitudes

Dose assessment procedures for cosmic radiation exposure of aircraft crew have been introduced in most European countries in accordance with the corresponding European directive and national regulations. However, the radiation exposure due to solar particle events is still a matter of scientific research. Here we describe the European research project CONRAD, WP6, Subgroup-B, about the current status of available solar storm measurements and existing models for dose estimation at flight altitudes during solar particle events leading to ground level enhancement (GLE). Three models for the numerical dose estimation during GLEs are discussed. Some of the models agree with limited experimental data reasonably well. Analysis of GLEs during geomagnetically disturbed conditions is still complex and time consuming. Currently available solar particle event models can disagree with each other by an order of magnitude. Further research and verification by on-board measurements is still neede

Patient satisfaction with anaesthesia care: development of a psychometric questionnaire and benchmarking among six hospitals in Switzerland and Austria†‡

Background. We describe the development and comparison of a psychometric questionnaire on patient satisfaction with anaesthesia care among six hospitals. Methods. We used a rigorous protocol: generation of items, construction of the pilot questionnaire, pilot study, statistical analysis (construct validity, factor analysis, reliability analysis), compilation of the final questionnaire, main study, repeated analysis of construct validity and reliability. We compared the mean total problem score and the scores for the dimensions: ‘Information/Involvement in decision‐making', and ‘Continuity of personal care by anaesthetist'. The influence of potential confounding variables was tested (multiple linear regression). Results. The average problem score from all hospitals was 18.6%. Most problems are mentioned in the dimensions ‘Information/Involvement in decision‐making' (mean problem score: 30.9%) and ‘Continuity of personal care by anaesthetist' (mean problem score: 32.2%). The overall assessment of the quality of anaesthesia care was good to excellent in 98.7% of cases. The most important dimension was ‘Information/Involvement in decision‐making'. The mean total problem score was significantly lower for two hospitals than the total mean for all hospitals (significantly higher at two hospitals) (P<0.05). Amongst the confounding variables considered, age, sex, subjective state of health, type of anaesthesia and level of education had an influence on the total problem score and the two dimensions mentioned. There were only marginal differences with and without the influence of the confounding variables for the different hospitals. Conclusions. A psychometric questionnaire on patient satisfaction with anaesthesia care must cover areas such as patient information, involvement in decision‐making, and contact with the anaesthetist. The assessment using summed scores for dimensions is more informative than a global summed rating. There were significant differences between hospitals. Moreover, the high problem scores indicate a great potential for improvement at all hospitals. Br J Anaesth 2002; 89: 863-7

Galactic Abundances: Report of Working Group 3

We summarize the various methods and their limitations and strengths to derive galactic abundances from in-situ and remote-sensing measurements, both from ground-based observations and from instruments in space. Because galactic abundances evolve in time and space it is important to obtain information with a variety of different methods covering different regions from the Very Local Insterstellar Medium (VLISM) to the distant galaxy, and different times throughout the evolution of the galaxy. We discuss the study of the present-day VLISM with neutral gas, pickup ions, and Anomalous Cosmic Rays, the study of the local interstellar medium (ISM) at distances <1.5 kpc utilizing absorption line measurements in H I clouds, and the study of galactic cosmic rays, sampling contemporary (~15 Myr) sources in the local ISM within a few kiloparsec of the solar system. Solar system abundances, derived from solar abundances and meteorite studies are discussed in several other chapters of this volume. They provide samples of matter from the ISM from the time of solar system format ion, about 4.5 Gyr ago. The evolution of galactic abundances on longer time scales is discussed in the context of nuclear synthesis in the various contributing stellar objects

Device grade microcrystalline silicon owing to reduced oxygen contamination

As-deposited undoped microcrystalline silicon (µc-Si:H) has in general a pronounced n-type behavior. Such a material is therefore often not appropriate for use in devices, such as p-i-n diodes, as an active, absorbing i layer or as channel material for thin-film transistors. In recent work, on p-i-n solar cells, this disturbing n-type character had been successfully compensated by the ``microdoping'' technique. In the present letter, it is shown that this n-type behavior is mainly linked to oxygen impurities; therefore, one can replace the technologically delicate microdoping technique by a purification method, that is much easier to handle. This results in a reduction of oxygen impurities by two orders of magnitude; it has, furthermore a pronounced impact on the electrical properties of µc-Si:H films and on device performance, as well. Additionally, these results prove that the unwanted donor-like states within µc-Si:H are mainly due to extrinsic impurities and not to structural native defects

Treatment options of invasive fungal infections in adults.

A panel of infectious disease specialists, clinical microbiologists and hospital epidemiologists of the five Swiss university hospitals reviewed the current literature on the treatment of invasive fungal infections in adults and formulated guidelines for the management of patients in Switzerland. For empirical therapy of Candida bloodstream infection, fluconazole is the drug of choice in non-neutropenic patients with no severe sepsis or septic shock or recent exposure to azoles. Amphotericin B deoxycholate or caspofungin would be the treatment option for patients with previous azole exposure. In neutropenic patients, empirical therapy with amphotericin B deoxycholate is considered first choice. In patients with severe sepsis and septic shock, caspofungin is the drug of first choice. For therapy of microbiologically-documented Candida infection, fluconazole is the drug of choice for infections due to C. albicans, C. tropicalis or C. parapsilosis. When infections are caused by C. glabrata or by C. krusei, caspofungin or amphotericin B deoxycholate are first line therapies. Treatment guidelines for invasive aspergillosis (IA) were stratified into primary therapy, salvage therapy and combination therapy in critically ill patients. Voriconazole is recommended for primary (ie upfront) therapy. Caspofungin, voriconazole (if not used for primary therapy) or liposomal amphotericin B are recommended for salvage therapy for refractory disease. Combination therapy with caspofungin plus voriconazole or liposomal amphotericin B should be considered in critically ill patients. Amphotericin B deoxycholate is recommended as initial therapy for the empirical therapy in patients with neutropenia and persistent fever with close monitoring of adverse events

Mental health of help‐seeking outpatients pre and post COVID‐19: A real‐world data, multicentre study

Objective A great deal of research addresses the mental health implications of the COVID‐19 pandemic for the general population. Little is known about the implications for mental health of help‐seeking outpatients and for the effectiveness of mental health services. The present study investigated the mental health and treatment response of help‐seeking outpatients before and during the COVID‐19 pandemic. Method Routine outcome monitoring data from 3706 clients in the United States and Northern Europe was analysed using multilevel modelling with global subjective well‐being as the dependent variable.ResultsAs opposed to before the pandemic, during the pandemic, well‐being scores were significantly higher at intake and improvement throughout treatment was significantly smaller in the US sample, while both were comparable in the EU sample. Conclusion Although there is also evidence of less effective treatments since the pandemic, no conclusive picture emerges that portrays the impact of the pandemic on mental health as uniform. More research is needed to elucidate the impact of the pandemic on the help‐seeking population

Mental health of help-seeking outpatients pre and post COVID-19: A real-world data, multicentre study

Open access funding provided by Universitat Zurich