Human infection with Gongylonema pulchrum

A 43 year old woman developed a painful tumor at the left buccal mucosa. Following local anti-inflammatory treatment a 35 mm long, living female adult worm of Gongylonema pulchrum was extracted from the affected side. No further treatment was needed and recovery was complete 5 days after extraction. Infection had occurred possibly 6 weeks before in Hungary with ingestion of contaminated water from an open draw well. Although commonly occurring as parasitic infection of domestic cattle and other vertebrates, gongylonemiasis is very rare in humans. Only 48 cases have been described in the literature since 1864. Life cycle and pathology of G. pulchrum are discussed

Malaria in Nonimmune Travelers

Background: With the current increase of international travel to tropical endemic areas, the incidence of malaria being imported into nonendemic countries has increased significantly. Disagreement concerning malaria chemoprophylaxis and inadequate knowledge of malarious areas, morbidity, and pretravel advise has led to confusion among both health professionals as well as travelers. Therefore, this study was conducted to investigate malaria imported into Germany by identifying the high-risk endemic areas, clinical presentations, and chemoprophylactic and therapeutic regimens related to reported cases. Methods: Between 1990 and 1993, the 160 nonimmune travelers, all German nationals or residents for more than 10 years, presenting to our travel clinic with microscopically confirmed malaria were investigated. For each, the travel history, chemoprophylaxis used during travel, symptoms, pathological diagnosis, and treatment efficacy were analyzed. Results: Africa (73%), Asia (21%), and Central South America (6%) were the endemic countries visited by our patients, of whom only 3% used the chemoprophylaxis recommended for their destination. Plasmodium falciparum was the most common pathogen, found in more than half of our patients, and P. vivax (29%), P. ova le (6%), P. malariae(6%), a mixed infection with P.falciparum and P vivax (3%) were also detected. All patients presented with fever and headaches, a majority with profuse night sweats, insomnia, arthralgias, and myalgias, and diarrhea and abdominal cramps were experienced in 13% and 8%, respectively. In falciparum malaria, a recrudescence was observed in all patients who received chloroquine only, whereas quinine, halofantrine, and mefloquine were highly effective. In vivax malaria, a relapse rate of 14% was noted in the patients treated with the currently recommended regimen of chloroquine and primaquine. Conclusions: Visitors to endemic countries, especially to Africa, are of significant risk. Given the low compliance rate of chemoprophylaxis, a high percentage of malaria in our patients could have been avoided by an appropriate prophylaxis regimen and optimal pretravel counseling

Cutaneos larva migrans in travelers

The symptoms, medical history, and treatment of 98 patients with cutaneous larva migrans (creeping eruption) who attended a travel-related-disease clinic during a period of 4 years are reviewed. This condition is caused by skin-penetrating larvae of nematodes, mainly of the hookworm Ancylostoma braziliense and other nematodes of the family Ancylostomidae. Despite the ubiquitous distribution of these nematodes, in the investigated group only travelers to tropical and subtropical countries were affected; 28.9% of the patients had symptoms for > 1 month, and for 24.5% the probable incubation period was > 2 weeks. The efflorescences typically were on the lower extremities (73.4% of all locations). The buttocks and anogenital region were affected in 12.6% of all locations, and the trunk and upper extremities each were affected in 7.1%. Only a minority of patients presented with eosinophilia or an elevated serum level of IgE. No other laboratory data appeared to be related to the disease. Therapy with topical thiabendazole was successful for 98% of the patients. Systemic antihelmintic therapy was necessary in two cases because of disseminated, extensive infection

Gnathostomiasis nach Aufenthalt in Thailand.

During a 4-week holiday in Thailand a 13-year-old boy from Germany briefly fell ill with diarrhoea without blood-tinged stools and fever. 5 months later oedematous, reddish swellings occurred, at first on the right upper arm, later over the right side of the chest. Especially at night these swellings were associated with severe local and generalized itching. Bilaterally the axillary lymph-nodes were hard and slightly enlarged. There was a marked eosinophilia of 56%, the white count was 22,700/microliters and the serum level of IgE was raised to 1777 IU/ml. No worm eggs or larvae were found in the stool. Enzyme-linked immunosorbent assay, using larvae of Gnathostoma spinigerum as antigen, demonstrated antibodies against this nematode. Gnathostomiasis having been diagnosed treatment was started with albendazole (200 mg twice daily for 21 days), after which the boy was symptom free. After 2 months the eosinophilia had regressed to 10%, the white cell count was normal and the antibody titre had fallen

A Review of the External Validity of Clinical Trials with Beta-Blockers in Heart Failure

This is an open-access article distributed under the terms of the Creative Commons CC-BY-NC 3.0 License.Background: Beta-blockers (BBs) are the mainstay prognostic medication for all stages of chronic heart failure (CHF). There are many classes of BBs, each of which has varying levels of evidence to support its efficacy in CHF. However, most CHF patients have one or more comorbid conditions such as diabetes, renal impairment, and/or atrial fibrillation. Patient enrollment to randomized controlled trials (RCTs) often excludes those with certain comorbidities, particularly if the symptoms are severe. Consequently, the extent to which evidence drawn from RCTs is generalizable to CHF patients has not been well described. Clinical guidelines also underrepresent this point by providing generic advice for all patients. The aim of this review is to examine the evidence to support the use of BBs in CHF patients with common comorbid conditions. Methods: We searched MEDLINE, PubMed, and the reference lists of reviews for RCTs, post hoc analyses, systematic reviews, and meta-analyses that report on use of BBs in CHF along with patient demographics and comorbidities. Results: In total, 38 studies from 28 RCTs were identified, which provided data on six BBs against placebo or head to head with another BB agent in ischemic and nonischemic cardiomyopathies. Several studies explored BBs in older patients. Female patients and non-Caucasian race were underrepresented in trials. End points were cardiovascular hospitalization and mortality. Comorbid diabetes, renal impairment, or atrial fibrillation was detailed; however, no reference to disease spectrum or management goals as a focus could be seen in any of the studies. In this sense, enrollment may have limited more severe grades of these comorbidities. Conclusions: RCTs provide authoritative information for a spectrum of CHF presentations that support guidelines. RCTs may provide inadequate information for more heterogeneous CHF patient cohorts. Greater Phase IV research may be needed to fill this gap and inform guidelines for a more global patient population

Chiral metamaterials: retrieval of the effective parameters with and without substrate

After the prediction that strong enough optical activity may result in negative refraction and negative reflection, more and more artificial chiral metamaterials were designed and fabricated at difference frequency ranges from microwaves to optical waves. Therefore, a simple and robust method to retrieve the effective constitutive parameters for chiral metamaterials is urgently needed. Here, we analyze the wave propagation in chiral metamaterials and follow the regular retrieval procedure for ordinary metamaterials and apply it in chiral metamaterial slabs. Then based on the transfer matrix technique, the parameter retrieval is extended to treat samples with not only the substrate but also the top layers. After the parameter retrieval procedure, we take two examples to check our method and study how the substrate influences on the thin chiral metamaterials slabs. We find that the substrate may cause the homogeneous slab to be inhomogeneous, i.e. the reflections in forward and backward directions are different. However, the chiral metamaterial where the resonance element is embedded far away from the substrate is insensitive to the substrate.Comment: 15 pages, 6 figure

Epuraea imperialis (Reitter, 1877). New invasive species of Nitidulidae (Coleoptera) in Europe, with a checklist of sap beetles introduced to Europe and Mediterranean areas

Australian species Epuraea imperialis (Reitter, 1877), previously introduced to New Zealand, is recorded as a new invasive species from the Canary Islands, Continental Spain, Portugal, France, Belgium, and Italy. It is redescribed and figured, and its taxonomic position in the genus Epuraea Erichson, 1843 is discussed. A tentative checklist of sap beetles introduced to Europe and the Mediterranean areas is finally included

Concealing Secrets in Embedded Processors Designs

Side-channel analysis (SCA) attacks pose a serious threat to embedded systems. So far, the research on masking as a countermeasure against SCA focuses merely on cryptographic algorithms, and has either been implemented for particular hardware or software implementations. However, the drawbacks of protecting specific implementations are the lack of flexibility in terms of used algorithms, the impossibility to update protected hardware implementations, and long development cycles for protecting new algorithms. Furthermore, cryptographic algorithms are usually just one part of an embedded system that operates on informational assets. Protecting only this part of a system is thus not sufficient for most security critical embedded applications. In this work, we introduce a flexible, SCA-protected processor design based on the open-source V-scale RISC-V processor. The introduced processor design can be synthesized to defeat SCA attacks of arbitrary attack order. Once synthesized, the processor protects the computation on security-sensitive data against side-channel leakage. The benefits of our approach are (1) flexibility and updatability, (2) faster development of SCA-protected systems, (3) transparency for software developers, (4) arbitrary SCA protection level, (5) protection not only for cryptographic algorithms, but against leakage in general caused by processing sensitive data

Species D Adenoviruses as Oncolytics against B-cell Cancers

Purpose: Oncolytic viruses are self-amplifying anticancer agents that make use of the natural ability of viruses to kill cells. Adenovirus serotype 5 (Ad5) has been extensively tested against solid cancers, but less so against B-cell cancers because these cells do not generally express the coxsackie and adenoviral receptor (CAR). To determine whether other adenoviruses might have better potency, we mined the adenovirus virome of 55 serotypes for viruses that could kill B-cell cancers. Experimental Design: Fifteen adenoviruses selected to represent Ad species B, C, D, E, and F were tested in vitro against cell lines and primary patient B-cell cancers for their ability to infect, replicate in, and kill these cells. Select viruses were also tested against B-cell cancer xenografts in immunodeficient mice. Results: Species D adenoviruses mediated most robust killing against a range of B-cell cancer cell lines, against primary patient marginal zone lymphoma cells, and against primary patient CD138þ myeloma cells in vitro. When injected into xenografts in vivo, single treatment with select species D viruses Ad26 and Ad45 delayed lymphoma growth. Conclusions: Relatively unstudied species Dadenoviruses have a unique ability to infect and replicate in B-cell cancers as compared with other adenovirus species. These data suggest these viruses have unique biology in B cells and support translation of novel species D adenoviruses as oncolytics against B-cell cancers

A review of the external validity of clinical trials with beta-blockers in heart failure

Beta-blockers (BBs) are the mainstay prognostic medication for all stages of chronic heart failure (CHF). There are many classes of BBs, each of which has varying levels of evidence to support its efficacy in CHF. However, most CHF patients have one or more comorbid conditions such as diabetes, renal impairment, and/or atrial fibrillation. Patient enrollment to randomized controlled trials (RCTs) often excludes those with certain comorbidities, particularly if the symptoms are severe. Consequently, the extent to which evidence drawn from RCTs is generalizable to CHF patients has not been well described. Clinical guidelines also underrepresent this point by providing generic advice for all patients. The aim of this review is to examine the evidence to support the use of BBs in CHF patients with common comorbid conditions.We searched MEDLINE, PubMed, and the reference lists of reviews for RCTs, post hoc analyses, systematic reviews, and meta-analyses that report on use of BBs in CHF along with patient demographics and comorbidities.In total, 38 studies from 28 RCTs were identified, which provided data on six BBs against placebo or head to head with another BB agent in ischemic and nonischemic cardiomyopathies. Several studies explored BBs in older patients. Female patients and non-Caucasian race were underrepresented in trials. End points were cardiovascular hospitalization and mortality. Comorbid diabetes, renal impairment, or atrial fibrillation was detailed; however, no reference to disease spectrum or management goals as a focus could be seen in any of the studies. In this sense, enrollment may have limited more severe grades of these comorbidities.RCTs provide authoritative information for a spectrum of CHF presentations that support guidelines. RCTs may provide inadequate information for more heterogeneous CHF patient cohorts. Greater Phase IV research may be needed to fill this gap and inform guidelines for a more global patient population.Pupalan Iyngkaran, Samia R. Toukhsati, Merlin C. Thomas, Michael V. Jelinek, David L. Hare and John D. Horowit