Epidemiologie, Klinik und Therapie der Hakenwurm-assoziierten Larva migrans cutanea in Manaus, Brasilien

Einführung: Die Hakenwurm-assoziierte Larva migrans cutanea (HrCLM) ist eine parasitäre Hauterkrankung, die durch die Migration von tierpathogenen Hakenwurmlarven in der Epidermis ausgelöst wird. Diese führt zu einer kutanen Entzündungsreaktion, die sich als erhabener, meist serpiginiöser Larvengang präsentiert und von starkem Juckreiz begleitet ist. Da Umweltfaktoren wie Temperatur und Feuchtigkeit die Überlebensdauer der Eier und Larven im Boden beeinflussen, ist sie nur in tropischen und subtropischen Gebieten endemisch. Bevölkerungsbasierte Daten zu Epidemiologie und Klinik der HrCLM existieren nur aus dem Nordosten Brasiliens mit einem semiariden Klima. Therapiestudien wurden bislang nur an Reiserückkehrern durchgeführt. Methoden: Im tropischen Monsunklima von Manaus in Brasilien wurden in einem Armutsviertel eine Quer- und eine prospektive Längsschnittstudie durchgeführt. Für die Querschnittuntersuchung wurden Prävalenz, Risikofaktoren und Klinik der HrCLM in der Gesamtbevölkerung untersucht. Anschließend wurden über insgesamt 6 Monate mit einer Kohorte von Kindern die Risikofaktoren prospektiv überprüft und monatlich Inzidenz und klinische Merkmale der HrCLM bestimmt. Die Wirksamkeit von Ivermectin wurde anhand einer offenen Therapiestudie in insgesamt 7 Armutsvierteln in Manaus untersucht. Ergebnisse: Die Prävalenz in der Gesamtbevölkerung betrug 8.2% (95% Konfidenzintervall [KI], 6.3–10.1%), die Inzidenz in der Kohorte 0.52 Infektionen/Personenjahr (95% KI, 0.42-0.65). Monatliche Schwankungen der Prävalenz korrelierten mit der Niederschlagsmenge, ebenso wie die Anzahl der Läsionen. Auch Lokalisation und bakterielle Superinfektionen zeigten eine Saisonalität. Als unabhängige Risikofaktoren wurden Alter von 10-14 Jahren, männliches Geschlecht, Armut und Barfußlaufen identifiziert. Das bevölkerungsbezogene attributable Risiko von Barfußlaufen betrug 45%. Nach Therapie mit Ivermectin per os reduzierten sich Schweregrad und Anzahl der Läsionen innerhalb von zwei Wochen signifikant. Schlussfolgerung: Auch im feuchten tropischen Monsunklima von Manaus findet sich eine Saisonalität von Erkrankungshäufigkeit und Klinik der HrCLM, die mit der monatlichen Niederschlagsmenge korreliert. Es wurde die weltweit höchste bisher bekannte Prävalenz und Inzidenz festgestellt. Der einzige Risikofaktor, der einer direkten Intervention zugänglich wäre, ist das Barfußlaufen. HrCLM ist eine Armuts-assoziierte Erkrankung. Ivermectin per os zeigte auch in diesem Setting eine gute Wirksamkeit.Introduction: Hookworm-related cutaneous larva migrans (HrCLM) is a neglected parasitic skin disease, caused by the migration of canine or feline hookworm-larvae in the human epidermis. Environmental factors such as temperature and soil moisture influence survival of hookworm eggs and larvae. HrCLM is endemic in subtropical and tropical regions, though population-based data on morphology and epidemiology in a tropical climate is lacking. Therapy has never been evaluated in an endemic area. Methods: Epidemiology, morphology and clinical effectiveness of ivermectin were investigated by a cross-sectional, a prospective longitudinal study and an open clinical trial in the tropical monsoon climate of Manaus, Brazil. For the cross-sectional study the entire population of a resource-poor neighbourhood was examined to determine prevalence, risk factors and clinical characteristics. A cohort was formed out of all children and observed for further 5 months in order to verify the identified risk factors prospectively and investigate seasonal variation of morbidity. The observational therapy study was conducted in different resource-poor neighbourhoods. Effectiveness on morphology and associated morbidity was assessed 2 and 4 weeks after a single dose of oral ivermectin (200 μg/kg). Results: Prevalence among the total population was 8.2% (95% confidence interval [CI], 6.3–10.1%). Incidence among children was 0.52 cases per person-year (95% CI, 0.42-0.65). Seasonal variations in prevalence and infection intensity correlated with the amount of monthly precipitation. Seasonal variation also existed regarding the lesions´ localisation and the frequency of bacterial superinfection. Male sex, walking barefoot on sandy ground, poverty and age between 10 and 14 years were independent predictors of HrCLM. The Population Attributable Fraction (PAF) related to walking barefoot on sandy ground was 45%. A single-dose of oral ivermectin reduced amount and severity of the lesions significantly. Conclusion: Even in the tropical monsoon climate of Manaus a seasonal variation of morbidity peaking in the rainy season exists. Nowhere else has been described a higher prevalence/ incidence. Walking barefoot is the only risk factor amenable to intervention. HrCLM is a poverty-related disease. As ivermectin showed high effectiveness in this endemic area it would be desirable to make it available to the poorest part of population, which has to carry the highest disease burden

Prevalence and Infection Intensity of Human and Animal Tungiasis in Napak District, Karamoja, Northeastern Uganda

Tungiasis is an important but highly neglected cause of morbidity in resource-poor communities in Latin America and sub-Saharan Africa. Data upon which implementation of control measures can be based are scarce. Before piloting an integrated tungiasis control program in three parishes of Napak district, Uganda, a cross-sectional survey involving the systematic examination of humans and domestic mammals was implemented to establish the occurrence patterns of tungiasis. The study population was 5482 residents, of which 4035 (73.6%) participated in the study. The prevalence of tungiasis in humans was 62.8% (95% CI: 61.3–64.3%), with slightly more males than females affected (p = 0.01). Age-specific prevalence and intensity of human tungiasis followed an S-curve pattern, with children of 5–14 years and the elderly (≥60 years) being the most affected. Half of all lesions (50%) had been manipulated by sharp objects. The prevalence of tungiasis in animals was lower (14.2%, 95% CI: 10.9–18.0) than that of humans (p < 0.001). Animal tungiasis occurred in decreasing order of frequency in pigs (80%), dogs (24%), goats (16.3%), cats (8.1%) and sheep (4.9%). In conclusion, human tungiasis was highly prevalent but animal infections were comparatively few in the study area. Nevertheless, effective control measures should be based on One Health principles

Bugs That Can Resist Antibiotics but Not Men: Gender-Specific Differences in Notified Infections and Colonisations in Germany, 2010–2019

Data from surveillance networks show that men have a higher incidence rate of infections with anti-microbial-resistant (AMR) pathogens than women. We systematically analysed data of infections and colonisations with AMR pathogens under mandatory surveillance in Germany to quantify gender-specific differences. We calculated incidence-rates (IR) per 100,000 person–years for invasive infections with Methicillin-resistant Staphylococcus aureus (MRSA), and for infections or colonisations with carbapenem-non-susceptible Acinetobacter spp. (CRA), and Enterobacterales (CRE), using the entire German population as a denominator. We limited the study periods to years with complete notification data (MRSA: 2010–2019, CRA/CRE: 2017–2019). We used Poisson regression to adjust for gender, age group, federal state, and year of notification. In the study periods, IR for all notifications were 4.2 for MRSA, 0.90 for CRA, and 4.8 for CRE per 100,000 person-–years. The adjusted IR ratio for infections of men compared to women was 2.3 (95% confidence interval [CI]: 2.2–2.3) for MRSA, 2.2 (95%CI: 1.9–2.7) for CRA, and 1.7 (95%CI: 1.6–1.8) for CRE. Men in Germany show about double the risk for infection with AMR pathogens than women. This was also true for colonisations, where data were available. Screening procedures and associated hygiene measures may profit from a gender-stratified approach.Peer Reviewe

Comparable outcome of liver transplantation with Histidine-Tryptophan-Ketoglutarate vs. University of Wisconsin preservation solution: a retrospective observational double-center trial

I studien har 12 elevgrupper från 10 kommunala skolor i Malmö studerats statistiskt frånläsåren 2005/06 till 2013/14. Utifrån elevernas socioekonomiska bakgrund undersöktes effekten av skolornas resursutbud för PISA-resultaten i årskurs 9. Genom teorier om skolan som arena för social reproduktion av medelklassens värden, visade analysen att skolan inte uppväger för arbetarklasselever utan eftergymnasialt utbildade föräldrar. Slutsatserna visade att observationsgruppernas höga lärarbehörighet kombinerat med ökad lärartäthet för utsatta elevgrupper, inte ensamt utjämnar bakgrundsrelaterad skolsegregation. Som insatskomplement bör skolornas elevsammansättning ses som en administrativt förändringsbar resurs, jämte utökat arbete för bredare konsensus mellan hem och skola kring utbildningens betydelse och form.This study carries out a Qualitative Comparative Analysis [QCA] of 12 groups of studentsfrom 10 public schools in Malmoe. Based on students’ socioeconomic background, the study examines the effect of school resources across 9 years of elementary school; on PISA results in grade 9. Using the theoretical framework that school is an institution to promote social reproduction of middle-class values; the analysis demonstrates that school does not compensate working class students. The study's conclusions where that the observation groups generally high teaching qualifications; combined with increased teacher ratio for vulnerable student groups, not alone were sufficient resources to equalize background related school segregation. These need to be complemented with a broader consensus between home and school about the importance of education and its execution. Also the school pupil homogeneous composition should thereto be seen as an administrative opportunity to level the playing field in the present segregated school situation

The Internet-of-Things Meets Business Process Management: Mutual Benefits and Challenges

The Internet of Things (IoT) refers to a network of connected devices collecting and exchanging data over the Internet. These things can be artificial or natural, and interact as autonomous agents forming a complex system. In turn, Business Process Management (BPM) was established to analyze, discover, design, implement, execute, monitor and evolve collaborative business processes within and across organizations. While the IoT and BPM have been regarded as separate topics in research and practice, we strongly believe that the management of IoT applications will strongly benefit from BPM concepts, methods and technologies on the one hand; on the other one, the IoT poses challenges that will require enhancements and extensions of the current state-of-the-art in the BPM field. In this paper, we question to what extent these two paradigms can be combined and we discuss the emerging challenges

Low‐voltage shock impedance measurements: A false sense of security

Background: Implantable cardioverter defibrillators use low-voltage shock impedance measurements to monitor the lead integrity. However, previous case reports suggest that low-voltage shock impedance measurements may fail to detect insulation breaches that can cause life-threatening electrical short circuits. Methods and results: We report six cases of insulation breaches in transvenous defibrillation leads that were not obvious during standard interrogations and testing of the lead beforehand. In two cases, an electrical short circuit during commanded shock delivery for internal electrical cardioversion resulted in a total damage of the ICD generator. In one of these cases, commanded shock delivery induced ventricular fibrillation, which required external defibrillation. In two cases, a shock due to ventricular tachycardia was aborted as the shock impedance was less than 20 Ω. However, in both cases the tiny residual shock energy terminated the ventricular tachycardia. In contrast, in one case the residual energy of the aborted shock did not end ventricular fibrillation induced at defibrillator threshold testing. In one case, the ICD indicated an error code for a short circuit condition detected during an adequate shock delivery. Conclusions: This case series illustrates that low-voltage shock impedance measurements can fail to detect insulation breaches. These data suggest that in patients without a contraindication, traditional defibrillator threshold testing or high voltage synchronized shock at the time of device replacement should be considered

COSIK – COVID-19-Surveillance in Krankenhäusern

Um die Belastung der Krankenhäuser durch die COVID-19-Pandemie darzustellen und auch nosokomiale SARS-CoV-2-Infektionen zu erfassen, hat das RKI in Zusammenarbeit mit dem Nationalen Referenzzentrum für die Surveillance von nosokomialen Infektionen an der Charité Berlin eine systematische Krankenhaus-Surveillance von SARS-CoV-2-Infektionen in Deutschland, COSIK, entwickelt

Ageing in Europe. Empirical Analysis with the Survey of Health, Ageing and Retirement in Europe

Dieser Band versammelt Beiträge zu ausgewählten Konsequenzen der Bevölkerungsalterung, die auf ein Forschungspraktikum im Fach Bevölkerungswissenschaft an der Universität Bamberg zurückgehen. Die behandelten Untersuchungsgegenstände umfassen die Determinanten intergenerationaler instrumenteller Transfers im europäischen Vergleich, die Effekte von Arbeitsmarktstrukturen auf freiwillige und unfreiwillige Frühverrentung in Deutschland sowie den Zusammenhang von Versicherungsart und der Inanspruchnahme allgemeinmedizinischer Leistungen im Alter. Diese aktuellen sozialwissenschaftlichen Fragestellungen werden anhand der Daten der ersten Welle des Survey of Health, Ageing and Retirement in Europe (SHARE) empirisch untersucht.This volume brings together selected contributions on the consequences of population ageing which evolved in an empirical research training course in population studies at the University of Bamberg. The topics ranged from the determinants of intergenerational instrumental transfers in a European comparative perspective, the effects of labor market structures on voluntary and involuntary early retirement in Germany as well as the relation between private and public health insurance and medical treatment for aged people. These actual research questions were empirically investigated using the first wave of the Survey of Health, Ageing and Retirement in Europe (SHARE)

TIGIT Expression on Intratumoral Lymphocytes Correlates with Improved Prognosis in Oral Squamous Cell Carcinoma

Background: T-cell immunoglobulin and ITIM domain (TIGIT) is a potential immunotherapeutic target in a variety of malignant entities, and antibody-based treatments are currently under investigation in clinical trials. While promising results were observed in patients with lung cancer, the role of TIGIT in oral squamous cell carcinoma (OSCC) as a biomarker as well as a therapeutic target remains elusive. Therefore, we evaluated the role of TIGIT as a prognostic factor in OSCC. Methods: Here, we describe the results of a retrospective tissue microarray (TMA) OSCC cohort. Using immunohistochemistry, TIGIT expression was correlated with overall and recurrence-free survival (OAS and RFS, respectively). Additionally, in silico analysis was performed based on the TCGA Head and Neck Squamous Cell Carcinoma (HNSCC) cohort in order to correlate patients’ survival with TIGIT and CD274 (encoding for PD-L1) gene expression levels. Results: Database analysis revealed a beneficial outcome in OAS for tumor patients with high intraepithelial CD3-TIGIT-expression (n = 327). Hereby, OAS was 53.9 months vs. 30.1 months for patients with lower TIGIT gene expression levels (p = 0.033). In our retrospective OSCC-TMA cohort, elevated TIGIT levels on CD3+ cells correlated significantly with improved OAS (p = 0.025) as well as distant RFS (p = 0.026). Conclusions: This study introduces TIGIT as a novel prognostic factor in OSCC, indicating the improved outcome of OSCC patients relative to their increased TIGIT expression. TIGIT might provide therapeutic implications for future immunotherapy in advanced-stage OSCC patients