Fieber, Husten und Dyspnoe bei einer nierentransplantierten 38-jährigen Patientin

Zusammenfassung: Eine 38-jährige nierentransplantierte Patientin stellte sich mit Fieber, Husten und Dyspnoe vor. Sie stand unter Immunsuppression mit Mycophenolat und Prednison. Aufgrund der Klinik wurde bei Nachweis pulmonaler Infiltrate die Diagnose einer ambulant erworbenen Pneumonie gestellt und eine antibiotische Therapie begonnen. Bei klinischer Verschlechterung musste die Patientin auf die Intensivstation verlegt werden. Trotz antibiotischer Therapie verbesserte sich der Zustand kaum. Im Verlauf wurde eine bronchoalveoläre Lavage durchgeführt, in der das Parainfluenza-1-Virus nachgewiesen werden konnte. Infektionen mit respiratorischen Viren können bei immunsupprimierten Patienten schwer verlaufen und gehen mit einer hohen Mortalität einher. Humane Parainfluenza-Viren sind die dritthäufigsten Erreger viraler Pneumonien. Molekulargenetische Nachweismethoden ermöglichen eine schnelle und sensitive Diagnostik an respiratorischen Materialien. Da die therapeutischen Möglichkeiten limitiert sind, kommt prophylaktischen Maßnahmen eine besondere Bedeutung z

HD 174005: another binary classified as lambda Boo

We demonstrate that HD 174005, a star recently classified as belonging to the lambda Boo group, is in reality a double lined spectroscopic binary; at some phases, the observed composite spectrum may be similar to that of a single star with weak metal lines.Comment: Accepted by A&

Simultane Behandlung von obliterativen Karotispathologien und koronarer Herzkrankheit: Aktuelles Konzept und Resultate der letzten 5Jahre

Zusammenfassung: Einführung: Die kombinierte Karotisendarteriektomie und aorto-coronare Baypassoperation (C-CABG) weisen ein hohes peri-operatives Risiko auf. Als Alternative wird in letzter Zeit das Stenting der Artera carotis interna propagiert. Das Fehlen von Level I Evidenz hat uns motiviert, die Resultate unserer C-CABG der letzten 5 Jahre zu evaluieren. Methoden und Patienten: Retrospektive Monozenterstudie von 113C-CABG, durchgeführt zwischen Januar 2000 und Dezember 2004. Das mediane Alter der Patienten betrug 65Jahre (22Patienten waren 80Jahre alt oder älter). Die Karotisendarteriektomie wurde vor der aortokoronaren Bypassoperation in derselben Narkose durchgeführt. Resultate: Die 30-Tages-Mortalität war ausschließlich kardial bedingt und betrug 4,4% (5/113). Die neurologischen Komplikationen waren ein Schlaganfall, der innerhalb von 30Tagen vollständig regredient war, und 3TIA (3,5%, 4/113). Schlussfolgerung: C-CABG mit initial durchgeführter Karotisendarteriektomie ist ein sicheres Verfahren mit niedriger neurologischer Komplikationsrate. Der riskante Anteil des kombinierten Eingriffs ist nicht die Karotisendarteriektomie, sondern die aortokoronare Revaskularisation. Demzufolge scheint das Stenting beim kombinierten Eingriff als Alternative nicht gerechtfertigt, solange keine klaren Vorteile hinsichtlich der Früh- und Langzeitresultate gegenüber der alleinigen Karotisendarteriektomie vorliege

Acute traumatic aortic rupture: early stent-graft repair

Objective: Prospective evaluation of early stent-graft repair of acute traumatic aortic rupture. Methods: Twelve patients with acute traumatic aortic rupture of the descending aorta, out of a series of 337 endovascular aortic procedures, were treated by implantation of self-expanding stent-grafts. The procedures were performed within a mean post-injury time-period of 5±7 days (median: 1 day). The feasibility of stent-grafting was assessed by CT scanning and echography. Implantation was performed under local (n=6), or general anesthesia (n=6) if patients were already intubated (n=5) or required a common iliac artery access (n=1). Results: The immediate technical success rate was 100%. There were no post-procedure complications in all but one patient, who died 12 h postoperatively (8% mortality). Complete sealing of the aortic rupture in the remaining 11 patients was confirmed by postoperative CT scans. There were no intervention-related morbidity or mortality during the mean follow-up of 17 months. One patient with peri-graft leakage was successfully repaired with an additional stent-graft 12 months postoperatively. Conclusion: Non-delayed or early stent-grafting in acute traumatic rupture of the descending aorta is feasible. This technique seems to be a valuable option, in particular when associated lesions may interfere with the surgical outcome. Immediate post-procedural CT scanning and/or echography should be performed, in order to rule out residual leakag

Indoor monitoring of heavy metals and NO2 using active monitoring by moss and palmes diffusion tubes

Background; : Indoor pollution is a real threat to human health all over the world. Indoor pollution derives from indoor sources (e.g. smoking, gas stoves, coated furniture) as well as from outdoor sources (e.g. industries, vehicles). Long-term monitoring measurements in indoor environments are missing to a large extent due to a lack of simple to operate measuring devices. Mosses proved well as biomonitors in hundreds of studies. Nevertheless, indoor use has been extremely scarce. Therefore, this study aimed to determine indoor and outdoor pollution by active biomonitoring using moss as well as NO2 samplers to analyse outdoor and indoor levels of pollution. We exposed moss (Pleurozium schreberi) for 8 weeks indoors and outdoors in 20 households in the city of Girona, Spain. Al, Cr, Cu, Zn, Sn, Cd, Pb, Mo, and Sb were analysed by moss-samplers. Additionally, NO2 was measured with Palmes diffusion tubes.; Results; : Compared to the pre-exposure analysis, concentrations of almost all elements both on indoor and outdoor mosses increased. Except for Cd, all metals and NO2 had, on average, higher concentrations in outdoor mosses than at corresponding indoor sites. However, some 20% of the samples showed inverse patterns, thus, indicating both indoor and outdoor sources. Indoor/outdoor correlations of elements were not significant, but highest for markers of traffic-related pollution, such as Sn, Sb, and NO2. The wide range of indoor-outdoor ratios of NO2 exemplified the relevance of indoor sources such as smoking or gas cooking. Though mostly excluded in this study, a few sites had these sources present.; Conclusions; : The study at hand showed that moss exposed at indoor sites could be a promising tool for long-time biomonitoring. However, it had also identified some drawbacks that should be considered in future indoor studies. Increments of pollutants were sometimes really low compared to the initial concentration and therefore not detectable. This fact hampers the investigation of elements with low basic element levels as, e.g. Pt. Therefore, moss with real low basic levels is needed for active monitoring, especially for future studies in indoor monitoring. Cloned material could be a proper material for indoor monitoring yet never was tested for this purpose

Predictors of complications in acute type B aortic dissection

Objectives: Medical treatment is generally advocated for patients with acute type B aortic dissection without complications. The objective of this retrospective analysis was to determine whether there are any initial findings that can help predict the long-term course of the disease. Methods: Case records of the 130 patients treated for type B aortic dissection between 1988 and 1997 were reviewed; 41 (31%) were operated on in the acute phase (≪14 days), 31 (24%) were operated on in the chronic phase and 58 (45%) were treated medically. Results: Overall acute mortality was 10.8%; 22% for patients operated on in the early phase and 5.6% for medically treated patients. Age (P=0.002), persistent pain (P=0.01) and malperfusion (P=0.001) were significant independent predictors of the need for surgery. Paraplegia/para paresis (P=0.0001), leg ischaemia (P=0.003), pleural effusion (P=0.003), rupture (P=0.0001), shock (P=0.0001), age (P=0.003), cardiac failure (P=0.002) and aortic diameter ≫4.5cm (P=0.002) were significant predictors of poor survival. Age and shock also emerged as independent risk factors. Patients without malperfusion (P=0.0001), pleural effusion (P=0.003), rupture (P=0.0001) and shock (P=0.0001) had a significantly better event-free survival (freedom from repeat surgery and death). The actuarial survival rate for high-risk patients (malperfusion, rupture, shock) was 62% at 1 year and 40% at 5 years; the corresponding values for low-risk patients were 94 and 84%, respectively. Conclusions: Rupture, shock and malperfusion are significant predictors of poor survival in patients with acute type B aortic dissectio

Assessment of Deaths Attributable to Air Pollution: Should We Use Risk Estimates based on Time Series or on Cohort Studies?

Epidemiologic studies are crucial to the estimation of numbers of deaths attributable to air pollution. In this paper, the authors present a framework for distinguishing estimates of attributable cases based on time-series studies from those based on cohort studies, the latter being 5-10 times larger. The authors distinguish four categories of death associated with air pollution: A) air pollution increases both the risk of underlying diseases leading to frailty and the short term risk of death among the frail; B) air pollution increases the risk of chronic diseases leading to frailty but is unrelated to timing of death; C) air pollution is unrelated to risk of chronic diseases but short term exposure increases mortality among persons who are frail; and D) neither underlying chronic disease nor the event of death is related to air pollution exposure. Time-series approaches capture deaths from categories A and C, whereas cohort studies assess cases from categories A, B, and C. In addition, years of life lost can only be derived from cohort studies, where time to death is the outcome, while in time-series studies, death is a once-only event (no dimension in time). The authors conclude that time-series analyses underestimate cases of death attributable to air pollution and that assessment of the impact of air pollution on mortality should be based on cohort studie

An empirical temperature calibration for the Delta a photometric system. II. The A-type and mid F-type star

With the Delta a photometric system, it is possible to study very distant galactic and even extragalactic clusters with a high level of accuracy. This can be done with a classical color-magnitude diagram and appropriate isochrones. The new calibration presented in this paper is a powerful extension. For open clusters, the reddening is straightforward for an estimation via Isochrone fitting and is needed in order to calculate the reddening-free, temperature sensitive, index (g1-y)0. As a last step, the calibration can be applied to individual stars. Because no a-priori reddening-free photometric parameters are available for the investigated spectral range, we have applied the dereddening calibrations of the Stromgren uvbybeta system and compared them with extinction models for the Milky Way. As expected from the sample of bright stars, the extinction is negligible for almost all objects. As a next step, already established calibrations within the Stromgren uvbybeta, Geneva 7-color, and Johnson UBV systems were applied to a sample of 282 normal stars to derive a polynomial fit of the third degree for the averaged effective temperatures to the individual (g1-y)0 values with a mean of the error for the whole sample of Delta T(eff) is 134K, which is lower than the value in Paper I for hotter stars. No statistically significant effect of the rotational velocity on the precision of the calibration was found.Comment: 5 pages, 2 figures, accepted by A&

Heart rate variability in association with frequent use of household sprays and scented products in SAPALDIA

Background: Household cleaning products are associated with adverse respiratory health outcomes, but the cardiovascular health effects are largely unknown.Objective: We determined if long-term use of household sprays and scented products at home was associated with reduced heart rate variability (HRV), a marker of autonomic cardiac dysfunction.Methods: We recorded 24-hr electrocardiograms in a cross-sectional survey of 581 Swiss adults, 1, 1-3, or 4-7 days/week, unexposed (reference)] of using cleaning sprays, air freshening sprays, and scented products.Results: Decreases in 24-hr SDNN and TP were observed with frequent use of all product types, but the strongest reductions were associated with air freshening sprays. Compared with unexposed participants, we found that using air freshening sprays 4-7 days/week was associated with 11% [95% confidence interval (CI): -20%, -2%] and 29% (95% CI: -46%, -8%) decreases in 24-hr SDNN and TP, respectively. Inverse associations of 24-SDNN and TP with increased use of cleaning sprays, air freshening sprays, and scented products were observed mainly in participants with obstructive lung disease (p > 0.05 for interactions).Conclusions: In predominantly older adult women, long-term frequent use of household spray and scented products was associated with reduced HRV, which suggests an increased risk of cardiovascular health hazards. People with preexisting pulmonary conditions may be more susceptibl

Mortality attributable to ambient fine particulate matter and nitrogen dioxide in Switzerland in 2019: use of two-pollutant effect estimates

INTRODUCTION: Air pollution health risk assessments have traditionally used single-pollutant effect estimates for one proxy ambient air pollutant such as PM(2.5). Two-pollutant effect estimates, i.e. adjusted for another correlated pollutant, theoretically enable the aggregation of pollutant-specific health effects minimizing double-counting. Our study aimed at estimating the adult mortality in Switzerland in 2019 attributable to PM(2.5) from a single-pollutant effect estimate and to the sum of PM(2.5) and NO(2) from two-pollutant estimates; comparing the results with those from alternative global, European and Swiss effect estimates. METHODS: For the single-pollutant approach, we used a PM(2.5) summary estimate of European cohorts from the project ELAPSE, recommended by the European Respiratory Society and International Society for Environmental Epidemiology (ERS-ISEE). To derive the two-pollutant effect estimates, we applied ELAPSE-based conversion factors to ERS-ISEE PM(2.5) and NO(2) single-pollutant effect estimates. Additionally, we used World Health Organization 2021 Air Quality Guidelines as counterfactual scenario, exposure model data from 2019 and Swiss lifetables. RESULTS: The single-pollutant effect estimate for PM(2.5) (1.118 [1.060; 1.179] per 10 mug/m(3)) resulted in 2240 deaths (21,593 years of life lost). Using our derived two-pollutant effect estimates (1.023 [1.012; 1.035] per 10 mug/m(3) PM(2.5) adjusted for NO(2) and 1.040 [1.023; 1.058] per 10 mug/m(3) NO(2) adjusted for PM(2.5)), we found 1977 deaths (19,071 years of life lost) attributable to PM(2.5) and NO(2) together (23% from PM(2.5)). Deaths using alternative effect estimates ranged from 1042 to 5059. DISCUSSION: Estimated premature mortality attributable to PM(2.5) alone was higher than to both PM(2.5) and NO(2) combined. Furthermore, the proportion of deaths from PM(2.5) was lower than from NO(2) in the two-pollutant approach. These seemingly paradoxical results, also found in some alternative estimates, are due to statistical imprecisions of underlying correction methods. Therefore, using two-pollutant effect estimates can lead to interpretation challenges in terms of causality