Disseminated Invasive Aspergillosis with Cerebral Involvement Successfully Treated with Caspofungin and Voriconazole

We describe a case of cerebral aspergillosis which was successfully treated with a combination of caspofungin and voriconazole. The patient remains in remission 18 months after stopping antifungal treatment. We discuss primary and salvage therapy of invasive aspergillosis with focus on cerebral involvement. Since historical data showed a fatal outcome in most cases, amphotericin B does not cross the blood brain barrier while voriconazole does, we chose a combination of voriconazole plus caspofungin as primary therap

Air suctioning during colon biopsy acquisition reduces bacterial contamination

Background and Aim: Contamination of endoscopy suites with bacteria during procedures is of concern particularly through droplets during handling of biopsy specimens. It has been advocated that suctioning while removing the biopsy forceps could help to reduce potentially hazardous bioaerosols. The aim of the present study was to evaluate the efficacy of air suctioning during removal of the biopsy forceps. Materials and Methods: Airborne bacteria were collected by an impactor air-sampler (MAS-100). Fifty liters of air were collected continuously for 30 seconds at a 30 cm distance from the colonoscope suction channel. Room air samples were taken in the endoscopy suite in the morning prior to the beginning of the endoscopy program, during colonoscopy with a sham biopsy in the descending colon with and without suctioning and at the end of the procedure day. Standard 90 mm Petri dishes containing a selective medium for gram-positive cocci (CNA blood agar) were used with the impaction sampler and colony forming units/m3 (cfu) were determined. Results: Measurements were performed at fifty consecutive colonoscopies. Prior to the beginning of the endoscopy program, the bioaerosol burden in the colonoscopy suite reached a mean of 4.2 cfu/m3. During colonoscopies performed without suctioning at biopsy the bioaerosol burden increased to 29.4 cfu/m3 whereas this burden increased only to 15.1 cfu/m3 when the suctioning was applied during removal of the biopsy forceps. The difference in bioaerosol burden between suctioning and no suctioning was highly significant (p < 0.0005). At the end of the procedure day the airborne bacteria count dropped to 15.6 cfu/m3. The analysis of the colonies on the CNA blood agar identified predominantly enterococci. Staphylococci spp. and other gram-positive bacteria were rarely isolated. Conclusion: The present study indicates that the bioaerosol burden during handling of biopsy specimens is not neglectable but can be reduced by the simple habit of applying suctioning during acquisition of biopsies. This practice might be an important infection-control measure during gastrointestinal endoscopies

Akute Gefäßerkrankungen in der Gastroenterologie

Zusammenfassung: Vaskulär-gastroenterologische Notfälle zählen zu den häufigen Krankheitsbildern auf internistischen und chirurgischen Notfallstationen. Die klinischen Konsequenzen reichen von trivialen bis zu lebensbedrohlichen Situationen. Nur eine frühzeitige Erkennung der Symptomenkomplexe und die Anwendung der adäquaten diagnostischen Mittel führen zur korrekten Diagnosestellung mit nachfolgend - möglicherweise lebensrettender - Therapie. Um die hohen Mortalitätsraten der akuten Mesenterialischämien (50%), aortoenterischen Fisteln (30-40%), Aneurysmen viszeraler Arterien (10-100%) sowie des Budd-Chiari-Syndroms weiter senken zu können, gewinnen neue Strategien mit endovaskulärem Therapieansatz zunehmend an Bedeutung und ersetzen teilweise über viele Jahrzehnte etablierte Diagnose- und Therapiealgorithmen. Diese Übersichtsarbeit soll einen Überblick über aktuelle Diagnostik- und Therapiekonzepte häufiger vaskulär-gastroenterologischer Notfälle verschaffe

The Palomar Testbed Interferometer

The Palomar Testbed Interferometer (PTI) is a long-baseline infrared interferometer located at Palomar Observatory, California. It was built as a testbed for interferometric techniques applicable to the Keck Interferometer. First fringes were obtained in July 1995. PTI implements a dual-star architecture, tracking two stars simultaneously for phase referencing and narrow-angle astrometry. The three fixed 40-cm apertures can be combined pair-wise to provide baselines to 110 m. The interferometer actively tracks the white-light fringe using an array detector at 2.2 um and active delay lines with a range of +/- 38 m. Laser metrology of the delay lines allows for servo control, and laser metrology of the complete optical path enables narrow-angle astrometric measurements. The instrument is highly automated, using a multiprocessing computer system for instrument control and sequencing.Comment: ApJ in Press (Jan 99) Fig 1 available from http://huey.jpl.nasa.gov/~bode/ptiPicture.html, revised duging copy edi

Population density, water supply, and the risk of dengue fever in Vietnam: cohort study and spatial analysis.

BACKGROUND: Aedes aegypti, the major vector of dengue viruses, often breeds in water storage containers used by households without tap water supply, and occurs in high numbers even in dense urban areas. We analysed the interaction between human population density and lack of tap water as a cause of dengue fever outbreaks with the aim of identifying geographic areas at highest risk. METHODS AND FINDINGS: We conducted an individual-level cohort study in a population of 75,000 geo-referenced households in Vietnam over the course of two epidemics, on the basis of dengue hospital admissions (n = 3,013). We applied space-time scan statistics and mathematical models to confirm the findings. We identified a surprisingly narrow range of critical human population densities between around 3,000 to 7,000 people/km² prone to dengue outbreaks. In the study area, this population density was typical of villages and some peri-urban areas. Scan statistics showed that areas with a high population density or adequate water supply did not experience severe outbreaks. The risk of dengue was higher in rural than in urban areas, largely explained by lack of piped water supply, and in human population densities more often falling within the critical range. Mathematical modeling suggests that simple assumptions regarding area-level vector/host ratios may explain the occurrence of outbreaks. CONCLUSIONS: Rural areas may contribute at least as much to the dissemination of dengue fever as cities. Improving water supply and vector control in areas with a human population density critical for dengue transmission could increase the efficiency of control efforts. Please see later in the article for the Editors' Summary

Deeply sequenced metagenome and metatranscriptome of a biogas-producing microbial community from an agricultural production-scale biogas plant

Bremges A, Maus I, Belmann P, et al. Deeply sequenced metagenome and metatranscriptome of a biogas-producing microbial community from an agricultural production-scale biogas plant. GigaScience. 2015;4(1): 33.Background The production of biogas takes place under anaerobic conditions and involves microbial decomposition of organic matter. Most of the participating microbes are still unknown and non-cultivable. Accordingly, shotgun metagenome sequencing currently is the method of choice to obtain insights into community composition and the genetic repertoire. Findings Here, we report on the deeply sequenced metagenome and metatranscriptome of a complex biogas-producing microbial community from an agricultural production-scale biogas plant. We assembled the metagenome and, as an example application, show that we reconstructed most genes involved in the methane metabolism, a key pathway involving methanogenesis performed by methanogenic Archaea. This result indicates that there is sufficient sequencing coverage for most downstream analyses. Conclusions Sequenced at least one order of magnitude deeper than previous studies, our metagenome data will enable new insights into community composition and the genetic potential of important community members. Moreover, mapping of transcripts to reconstructed genome sequences will enable the identification of active metabolic pathways in target organisms