Response of HIV-infected patients with syphilis to therapy with penicillin or intravenous ceftriaxone

<p>Abstract</p> <p>Background</p> <p>Ceftriaxone is commonly used as an alternative antibiotic drug in treating syphilis but clinical data on its efficacy are limited. Objective: To evaluate the response of HIV-infected patients with active syphilis to treatment with penicillin or ceftriaxone.</p> <p>Methods</p> <p>A retrospective study involving 24 consecutive patients with a positive Veneral Disease Research Laboratory test (VDRL) and at least one specific treponemal test. 12 patients were treated with different regimens of high-dose penicillin G for at least 2 weeks. Another 12 patients were treated with ceftriaxone 1-2 g per day intravenously for 10-21 days.</p> <p>Results</p> <p>After a median follow up of 18,3 months all patients of the penicillin-treated group and 11 of 12 ceftriaxone-treated patients showed a ≥ 4-fold decline in VDRL-titers; 91% of them already within 6 months after therapy.</p> <p>Conclusion</p> <p>Our serological data demonstrate a comparable efficacy of currently recommened penicillin and ceftriaxone treatment regimens for active syphilis in HIV-infected patients.</p

Prevention, diagnosis, therapy and follow-up care of sepsis: 1st revision of S-2k guidelines of the German Sepsis Society (Deutsche Sepsis-Gesellschaft e.V. (DSG)) and the German Interdisciplinary Association of Intensive Care and Emergency Medicine (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI))

Practice guidelines are systematically developed statements and recommendations that assist the physicians and patients in making decisions about appropriate health care measures for specific clinical circumstances taking into account specific national health care structures. The 1st revision of the S-2k guideline of the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information (results of controlled clinical trials and expert knowledge) on the effective and appropriate medical care (prevention, diagnosis, therapy and follow-up care) of critically ill patients with severe sepsis or septic shock. The guideline had been developed according to the “German Instrument for Methodological Guideline Appraisal” of the Association of the Scientific Medical Societies (AWMF). In view of the inevitable advancements in scientific knowledge and technical expertise, revisions, updates and amendments must be periodically initiated. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources

Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units: a comparison of two large cohorts

Background: Mortality rates for patients with ARDS remain high. We assessed temporal changes in the epidemiology and management of ARDS patients requiring invasive mechanical ventilation in European ICUs. We also investigated the association between ventilatory settings and outcome in these patients. Methods: This was a post hoc analysis of two cohorts of adult ICU patients admitted between May 1–15, 2002 (SOAP study, n = 3147), and May 8–18, 2012 (ICON audit, n = 4601 admitted to ICUs in the same 24 countries as the SOAP study). ARDS was defined retrospectively using the Berlin definitions. Values of tidal volume, PEEP, plateau pressure, and FiO2 corresponding to the most abnormal value of arterial PO2 were recorded prospectively every 24&nbsp;h. In both studies, patients were followed for outcome until death, hospital discharge or for 60&nbsp;days. Results: The frequency of ARDS requiring mechanical ventilation during the ICU stay was similar in SOAP and ICON (327[10.4%] vs. 494[10.7%], p = 0.793). The diagnosis of ARDS was established at a median of 3 (IQ: 1–7) days after admission in SOAP and 2 (1–6) days in ICON. Within 24&nbsp;h of diagnosis, ARDS was mild in 244 (29.7%), moderate in 388 (47.3%), and severe in 189 (23.0%) patients. In patients with ARDS, tidal volumes were lower in the later (ICON) than in the earlier (SOAP) cohort. Plateau and driving pressures were also lower in ICON than in SOAP. ICU (134[41.1%] vs 179[36.9%]) and hospital (151[46.2%] vs 212[44.4%]) mortality rates in patients with ARDS were similar in SOAP and ICON. High plateau pressure (&gt; 29 cmH2O) and driving pressure (&gt; 14 cmH2O) on the first day of mechanical ventilation but not tidal volume (&gt; 8&nbsp;ml/kg predicted body weight [PBW]) were independently associated with a higher risk of in-hospital death. Conclusion: The frequency of and outcome from ARDS remained relatively stable between 2002 and 2012. Plateau pressure &gt; 29 cmH2O and driving pressure &gt; 14 cmH2O on the first day of mechanical ventilation but not tidal volume &gt; 8&nbsp;ml/kg PBW were independently associated with a higher risk of death. These data highlight the continued burden of ARDS and provide hypothesis-generating data for the design of future studies

A new sacred heart for the public space

A new church for the parish St. Elisabeth: a new heart for the community The central idea of the project is based on two strong intentions: keep the existent wall with the entrance terrace, as a pleasant opportunity to have a view on the landscape, and create a new intimate public space which relate all the activities in the block - the new church, the oratory, the kinder garden, the public library, the tea-room and the housing. The new church and the public library dialogue directly, at a quote of 3.50 mt, on the main public space, called the ‘square of twelve trees‘. The new parish is reachable from the lighting increasing ramp along the old wall and from the stairs of the public library, a sort of ‘door’ building. Walking along the wall, where the ‘via crucis’ mosaics are hanged, the persons arrive on the old terrace, a ‘hieratic’ and silent place. On the back of the church is possible sit on a bench in the thickness of the wall and look at the landscape in a quiet dimension. The inner sacred space is a very simple volume, built on a central plan (the square), in which the modulation of the light is the protagonist: coming through an horizontal ‘cut’ on the north side, from the top in the belt tower, and from down in the bottom of the church, behind the altar. A very flexible sacred room that could be used in many different configurations, fixing just the Baptist font – to ‘crop’ a special area for the sacrament – and the stairs which lead to the two upper galleries, a re-interpretation of an ancient ‘matroneo’. There’s another access at the terrace’s level: a covered passage introduce to the interior square, contented by a new building on south side. At the ground floor a long ‘portico’ offers some sheltered public place which distributes the entrances to the oratory and to a tea-room/café. At the other grounds there be new housing. The main level is also served by the system of stairs perpendicular to the Bohlleitenweg Strasse. The system reconfirm the existent transversal passage, linking the low level with the upper level of Bohlleitenweg Strasse and distributing the kinder garden, organized in a ‘cascade’ structure: three new buildings on three different floors but strictly connected by interior passages and cover corridors, sharing little intimate gardens, exclusive use of the children. It’s also possible that part of these spaces are used for housing