Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study

AbstractBackgroundThe optimal diagnostic strategy and timing of intervention in infected necrotizing pancreatitis is subject to debate. We performed a survey on these topics amongst a group of international expert pancreatologists.MethodsAn online survey including case vignettes was sent to 118 international pancreatologists. We evaluated the use and timing of fine needle aspiration (FNA), antibiotics, catheter drainage and (minimally invasive) necrosectomy.ResultsThe response rate was 74% (N = 87). None of the respondents use FNA routinely, 85% selectively and 15% never. Most respondents (87%) use a step-up approach in patients with infected necrosis. Walled-off necrosis (WON) is considered a prerequisite for endoscopic drainage and percutaneous drainage by 66% and 12%, respectively. After diagnosing infected necrosis, 55% routinely postpone invasive interventions, whereas 45% proceed immediately to intervention. Lack of consensus about timing of intervention was apparent on day 14 with proven infected necrosis (58% intervention vs. 42% non-invasive) as well as on day 20 with only clinically suspected infected necrosis (59% intervention vs. 41% non-invasive).DiscussionThe step-up approach is the preferred treatment strategy in infected necrotizing pancreatitis amongst expert pancreatologists. There is no uniformity regarding the use of FNA and timing of intervention in the first 2–3 weeks of infected necrotizing pancreatitis

Influence of Salmonella specific bacteriophages (O1; S16) on the shedding of naturally occurring Salmonella and an orally applied Salmonella Eastbourne strain in bearded dragons (Pogona vitticeps)

This study determined the passage time and phage propagation time of salmonella specific phages, Felix O1 and S16, in 10 bearded dragons, based on re‐isolation from cloacal swabs and faecal samples following oral administration, as a possible tool for reducing salmonella shedding. In Study 1, Felix O1 was administered orally for 12 consecutive days. Over 60 days, swabs were taken from the oral cavity and cloaca and qualitative Salmonella detection as well as salmonella quantification from faecal samples were performed. In Study 2, a phage cocktail (Felix O1 and S16) was administered to half of the tested animals. Salmonella (S.) Eastbourne was also given orally to all animals. Oral and cloacal swabs were tested as in Study 1, and faecal samples were collected for phage quantification. Various Salmonella serovars were detectable at the beginning of the study. The numbers of serovars detected declined over the course of the study. S. Kisarawe was most commonly detected. Salmonella titres ranged from 102 to 107 cfu/g faeces. The phages (Felix O1 and S16) were detectable for up to 20 days after the last administration. The initial phage titres ranged from 103 to 107 pfu/ml. The study shows that the phages were able to replicate in the intestine, and were shed for a prolonged period and therefore could contribute to a reduction of Salmonella shedding.Peer Reviewe

Herausforderungen der Legislaturperiode für die Tragfähigkeit der Renten- und Pflegeversicherung

Die Nachwirkungen der Wirtschaftskrise und die Lasten der Konjunkturprogramme werden den Bund und die Länder bereits in dieser Legislaturperiode zu umfangreichen Konsolidierungsmaßnahmen zwingen, um das durch die Schuldenbremse gesteckte Ziel eines strukturell ausgeglichenen Haushalts zu erreichen. Das eigentliche Tragfähigkeitsproblem der öffentlichen Haushalte ist jedoch nach wie vor auf die Folgen der demografischen Entwicklung für die Finanzen der umlagefinanzierten Sozialversicherungen zurückzuführen. Vor diesem Hintergrund untersucht der vorliegende Beitrag, welchen Herausforderungen sich die schwarz-gelbe Regierungskoalition in der laufenden Legislaturperiode stellen muss, um die Tragfähigkeit der gesetzlichen Rentenversicherung und der sozialen Pflegeversicherung zu gewährleisten. Abstract The aftermath of the economic crisis and the burden of the fiscal stimulus packages call for considerable consolidation efforts by federal and state governments to meet the goal of a structurally balanced budget as required by the German debt brake in the medium-run. However, the real challenge for the sustainability of Germany's public finances is still to be found in the consequences of demographic transition for the financial stability of Germany's mandatory social insurance schemes. For this reason, the present paper addresses the challenges faced by the newly elected German government in the current legislative period to cope with the fiscal burden of population ageing for the sustainability of Germany's public pension and long-term care insurance schemes. JEL Classifications: H55, H60, H6