Fluorokinolonien käyttö ja siihen liittyvät ongelmat

Fluorokinolonit ovat laajakirjoisia, suun kautta otettuna hyvin imeytyviä mikrobilääkkeitä, jotka tunkeutuvat erinomaisesti tulehtuneisiin kudoksiin. Käytön myötä mikrobilääkeresistenssi niitä kohtaan on lisääntynyt. Kokonaiskuva fluorokinolonien vaikeista haittavaikutuksista on täsmentynyt. Riski-hyötyarvioinnin tuloksena Euroopan lääkevirasto ja Euroopan komissio päättivät maaliskuussa 2019 fluorokinolonien käyttöä koskevista uusista ohjeista. Tärkeimmät käyttöaiheet avohoidossa ovat pyelonefriitit ja penisilliiniyliherkän potilaan keuhkokuume. Sairaalassa käyttöaiheina ovat lähinnä moniresistenttien bakteerien aiheuttamat infektiot ja niiden suun kautta toteutettava jatkohoito sekä vaikea, tehohoitoon johtanut keuhkokuume. Sekä avo- että sairaalahoitoon tarvittaisiin kansallinen mikrobilääkkeiden käyttösuositus.</p

The role of assistance dogs in society

Assistance dogs are specially trained to undertake a variety of tasks to help individuals with disabilities. This review gives an overview of the different types of assistance dogs in the UK, including guide dogs, hearing dogs, mobility assistance dogs, service dogs and dual purpose dogs. The literature describes many benefits of assistance dogs, including their impact on physical wellbeing and safety of their ‘owners,’ as well as on psychological wellbeing and social inclusion. The role of assistance dogs in society is widely recognized by the public, but is not currently acknowledged in government social policy. The current evidence on the benefits of assistance dogs is limited by the type and scale of current research. This article highlights the need for independent funding for high quality research to enable social care and policy makers to make evidence-based decisions on the value of assistance dogs to people with disabilities

On the phenology and seeding potential of sea-ice microalgal species

Sea ice is an important habitat for a wide variety of microalgal species. Depending on the species composition, sea ice can be a seeding source for pelagic phytoplankton blooms after ice melt in spring. Sea-ice algal communities were studied over 2 full winter seasons in 2014 and 2016 at Rothera Research Station, situated at the Western Antarctic Peninsula (WAP). Algal pigment patterns and microscopic observations were combined with photophysiological studies based on fluorescence analyses to monitor and explain the phenology of ice-algal species. Clear patterns in species succession were identified. Young sea ice contained a mixture of algal species including dinoflagellates, cryptophytes and diatoms like Chaetoceros spp. and Fragillariopsis spp. In winter, severe environmental conditions resulted in a decline in species diversity and selection towards heterotrophy. Pennate diatoms like Amphiprora kufferathii and Berkeleya adeliensis were the first to dominate the nutrient-enriched bottom-ice layers in early spring. The bottom communities exhibited a remarkably stable value for the photoadaptation parameter, E-k, of circa 25 mu mol photons m(-2) s(-1), Whereas pennate diatoms were most abundant in spring ice, the initial seeding event linked to ice melt was associated with flagellate species. Haptophyte species like Phaeocystis antarctica and prymnesiophytes like Pyramimonas spp. best sustained the transition from sea ice to seawater. Comparison with previous studies shows that the seeding patterns observed in Ryder Bay were characteristic over the wider sea-ice domain, Arctic and Antarctic. Over the course of this century, the WAP is predicted to experience continuing thinning and decline in sea-ice cover. For the near future, we expect that especially microalgal communities of haptophytes and chlorophytes will benefit from the changes, with yet unknown implications for carbon fluxes and higher trophic levels.Peer reviewe

Predictive Value of C-Reactive Protein (CRP) in Identifying Fatal Outcome and Deep Infections in Staphylococcus aureus Bacteremia

Peer reviewe

Prognostic utility of human complement factor H related protein test (the BTA stat® Test)

The purpose of the study was to determine, in addition to well-known prognostic factors, histological grade, stage, tumour size and multiplicity, the correlation of BTA stat Test on disease free interval (DFI) on primary superficial bladder cancer. A total of 116 patients with newly diagnosed bladder cancer were evaluated in a prospective multicentre study. A voided urine sample was obtained prior to TURB and split for culture, cytology and BTA stat testing. Follow-up data for the patients were collected until the first recurrence or the last visit and the DFI was analysed by Kaplan–Meier method and Cox analysis. Ninety-seven of the 116 (83.6%) patients were eligible for analysis. The BTA stat Test was positive in 73 (75.3%) patients, whereas cytology detected 20 (20.6%) cases. The DFI was found to be shorter among patients with a positive BTA stat Test, and also among those with intermediate or high-grade tumours. The BTA stat Test result divided patients with grade 2 tumours into two prognostic groups, in that those testing positive had 68.6% risk of recurrence during the first year compared to 42.9% risk of those with a negative test result (P = 0.041). Although the effect of tumour size on DFI was notable, the difference did not reach statistical significance (P = 0.064). Number of tumours was not related to DFI, nor was the difference between different stage of tumour of significance. BTA stat Test is not only sensitive in detection of primary bladder cancer, but also might have some independent prognostic significance. © 2001 Cancer Research Campaign http://www.bjcancer.co

Microalgal community structure and primary production in Arctic and Antarctic sea ice : A synthesis

Sea ice is one the largest biomes on earth, yet it is poorly described by biogeochemical and climate models. In this paper, published and unpublished data on sympagic (ice-associated) algal biodiversity and productivity have been compiled from more than 300 sea-ice cores and organized into a systematic framework. Significant patterns in microalgal community structure emerged from this framework. Autotrophic flagellates characterize surface communities, interior communities consist of mixed microalgal populations and pennate diatoms dominate bottom communities. There is overlap between landfast and pack-ice communities, which supports the hypothesis that sympagic microalgae originate from the pelagic environment. Distribution in the Arctic is sometimes quite different compared to the Antarctic. This difference may be related to the time of sampling or lack of dedicated studies. Seasonality has a significant impact on species distribution, with a potentially greater role for flagellates and centric diatoms in early spring. The role of sea-ice algae in seeding pelagic blooms remains uncertain. Photosynthesis in sea ice is mainly controlled by environmental factors on a small scale and therefore cannot be linked to specific ice types. Overall, sea-ice communities show a high capacity for photoacclimation but low maximum productivity compared to pelagic phytoplankton. Low carbon assimilation rates probably result from adaptation to extreme conditions of reduced light and temperature in winter. We hypothesize that in the near future, bottom communities will develop earlier in the season and develop more biomass over a shorter period of time as light penetration increases due to the thinning of sea ice. The Arctic is already witnessing changes. The shift forward in time of the algal bloom can result in a mismatch in trophic relations, but the biogeochemical consequences are still hard to predict. With this paper we provide a number of parameters required to improve the reliability of sea-ice biogeochemical models.Peer reviewe

Anorectal malformations

Anorectal malformations comprise a wide spectrum of diseases, which can affect boys and girls, and involve the distal anus and rectum as well as the urinary and genital tracts. They occur in approximately 1 in 5000 live births. Defects range from the very minor and easily treated with an excellent functional prognosis, to those that are complex, difficult to manage, are often associated with other anomalies, and have a poor functional prognosis. The surgical approach to repairing these defects changed dramatically in 1980 with the introduction of the posterior sagittal approach, which allowed surgeons to view the anatomy of these defects clearly, to repair them under direct vision, and to learn about the complex anatomic arrangement of the junction of rectum and genitourinary tract. Better imaging techniques, and a better knowledge of the anatomy and physiology of the pelvic structures at birth have refined diagnosis and initial management, and the analysis of large series of patients allows better prediction of associated anomalies and functional prognosis. The main concerns for the surgeon in correcting these anomalies are bowel control, urinary control, and sexual function. With early diagnosis, management of associated anomalies and efficient meticulous surgical repair, patients have the best chance for a good functional outcome. Fecal and urinary incontinence can occur even with an excellent anatomic repair, due mainly to associated problems such as a poorly developed sacrum, deficient nerve supply, and spinal cord anomalies. For these patients, an effective bowel management program, including enema and dietary restrictions has been devised to improve their quality of life

Microbial characteristics in homes of asthmatic and non-asthmatic adults in the ECRHS cohort

Microbial exposures in homes of asthmatic adults have been rarely investigated; specificities and implications for respiratory health are not well understood. The objectives of this study were to investigate associations of microbial levels with asthma status, asthma symptoms, bronchial hyperresponsiveness (BHR), and atopy. Mattress dust samples of 199 asthmatics and 198 control subjects from 7 European countries participating in the European Community Respiratory Health Survey II study were analyzed for fungal and bacterial cell wall components and individual taxa. We observed trends for protective associations of higher levels of mostly bacterial markers. Increased levels of muramic acid, a cell wall component predominant in Gram-positive bacteria, tended to be inversely associated with asthma (OR's for different quartiles: II 0.71 [0.39-1.30], III 0.44 [0.23-0.82], and IV 0.60 [0.31-1.18] P for trend .07) and with asthma score (P for trend .06) and with atopy (P for trend .02). These associations were more pronounced in northern Europe. This study among adults across Europe supports a potential protective effect of Gram-positive bacteria in mattress dust and points out that this may be more pronounced in areas where microbial exposure levels are generally lower.Peer reviewe