Nosokomiale Harnwegsinfektionen des Erwachsenen

Die Harnwegsinfektion ist die häufigste Infektion des Erwachsenen im Spital. Sie ist meistens mit dem Tragen von Harnwegskathetern assoziiert. Entscheidend sind daher die richtige Indikationsstellung für die Kathetereinlage, die frühzeitige Wiederentfernung des Katheters sowie die korrekte Diagnosestellung zur Vermeidung unnötiger antibiotischer Behandlungen. Die therapeutischen Überlegungen sollten die Komorbiditäten und potenzielle Behinderungen des Urinabflusses miteinschließen. In der Behandlung stehen Chinolone, Breitspektrumpenizilline und Cephalosporine der 3. Generation im Vordergrund. Bei den ökonomischen Überlegungen sollte v. a. der höhere Preis von i.v.-Antibiotika im Vergleich zu per os mit einfliessen. Urinary tract infection (UTI) is the most common infection in hospitalized adults. Nosocomial UTIs are mainly associated with the use of urinary catheters. Thus, the decision for catheterization should be made carefully and catheters removed in time. In order to prevent unnecessary antibiotic use in patients with urinary catheters correct diagnosis is crucial. Chinolones, broad-spectrum penicillins and third-generation cephalosporins are the mainstay of therapy. Comorbidities should be considered and potential obstructions of urinary flow removed. Economically important are the normally higher prices of i.v. antibiotics compared to oral use

Encapsulated high temperature PCM as active filler material in a thermocline-based thermal storage system

A great concern in Concentrated Solar Power (CSP) is to boost energy harvesting systems, by finding materials with enhanced thermal performance. Phase Change Materials (PCM) have emerged as a promising option, due to their high thermal storage density compared to sensible storage materials currently used in CSP. A thermal storage system for solar power plants is proposed, a thermocline tank with PCM capsules together with filler materials, based on multi-layered solid-PCM (MLSPCM) thermocline-like storage tank concept [1,2]. A detailed selection of the most suitable high temperature PCM, their containment materials and encapsulation methods are shown

Armschwellung und lokale Hautreaktion nach Di-Te-Impfung: 2 Fallbeispiele [Arm swelling and local skin reaction after Di-Te vaccination. 2 case reports]

Als Folge einer Di-Te-Impfung kam es bei zwei Patientinnen zu allergisch bedingten Hautreaktionen, die klinisch nicht einfach von einem Erysipel oder einer nekrotisierenden Fasziitis zu unterscheiden waren. Allergische Immunreaktionen vom Arthus-Typ sollten durch Antitoxin-Antikoerper diagnostisch belegt und dokumentiert werden. Vorbeugend ist das Vermeiden zu frueher Booster-Impfungen empfehlenswert. Die Lokalreaktion klingt gewoehnlich unter symptomatischer Therapie und zuwartender Verlaufsbeobachtung innerhalb weniger Tage ab

Atypisches Erythema induratum Bazin bei tuberkulöser Osteomyelitis

Hauttuberkulosen können sich mit sehr unterschiedlichen klinischen Bildern manifestieren und damit die Diagnosestellung erschweren. Wir stellen den Fall einer 79-jährigen Patientin vor, mit einer atypischen Präsentation eines Erythema induratum Bazin (EIB) am Oberkörper und einer tuberkulösen Osteomyelitis des Olekranon links. Aus den Biopsien der EIB-Knoten konnte M. tuberculosis kulturell nachgewiesen werden. Das widerspricht der klassischen Vorstellung, dass das EIB als Folge einer Hypersensitivitätsreaktion auf Mykobakterien entsteht, und unterstützt die Hypothese, dass das EIB auch durch eine hämatogene oder lymphogene Streuung von lebenden M. tuberculosis entstehen kann. Diagnosis of all types of cutaneous tuberculosis is challenging because the clinical picture of these diseases is highly variable. We describe the case of a 79-year old woman with an atypical presentation of Erythema induraturn Bazin (EIB) on the chest and left arm in association with a tuberculous osteomyelitis of the left olecranon. Surprisingly, M. tuberculosis grew also from biopsies of the EIB-lesions. This contradicts the conventional view that considers EIB (a tuberculid) to be caused by a hypersensitivity reaction to mycobacteria. The presented case supports the hypothesis that EIB may also be caused by hematogenous or lymphatic spread of viable M. tuberculosis

Polar compounds dominate in vitro effects of sediment extracts

Sediment extracts from three polluted sites of the river Elbe basin were fractionated using a novel online fractionation procedure. Resulting fractions were screened for mutagenic, aryl hydrocarbon receptor (AhR)-mediated, transthyretin (TTR)- binding, and estrogenic activities and their potency to inhibit gap junctional intercellular communication (GJIC) to compare toxicity patterns and identify priority fractions. Additionally, more than 200 compounds and compound classes were identified using GCMS/ MS, LC-MS/MS, and HPLC-DAD methods. For all investigated end points, major activities were found in polar fractions, which are defined here as fractions containing dominantly compounds with at least one polar functional group. Nonpolar PAH fractions contributed to mutagenic and AhR-mediated activities while inhibition of GJIC and estrogenic and TTR-binding activities were exclusively observed in the polar fractions. Known mutagens in polar fractions included nitro- and dinitro-PAHs, azaarenes, and keto-PAHs, while parent and monomethylated PAHs such as benzo[a]pyrene and benzofluoranthenes were identified in nonpolar fractions. Additionally, for one sample, high AhR-mediated activities were determined in one fraction characterized by PCDD/Fs, PCBs, and PCNs. Estrone, 17β-estradiol, 9H-benz[de]anthracen-7-one, and 4-nonylphenol were identified as possible estrogenic and TTR-binding compounds. Thus, not only nonpolar compounds such as PAHs, PCBs, and PCDD/Fs but also the less characterized and investigated more polar substances should be considered as potent mutagenic, estrogenic, AhR-inducing, TTR-binding, and GJIC-inhibiting components for future studies. © 2011 American Chemical Society

Transmission assessment surveys (TAS) to define endpoints for lymphatic filariasis mass drug administration: a multicenter evaluation.

BACKGROUND: Lymphatic filariasis (LF) is targeted for global elimination through treatment of entire at-risk populations with repeated annual mass drug administration (MDA). Essential for program success is defining and confirming the appropriate endpoint for MDA when transmission is presumed to have reached a level low enough that it cannot be sustained even in the absence of drug intervention. Guidelines advanced by WHO call for a transmission assessment survey (TAS) to determine if MDA can be stopped within an LF evaluation unit (EU) after at least five effective rounds of annual treatment. To test the value and practicality of these guidelines, a multicenter operational research trial was undertaken in 11 countries covering various geographic and epidemiological settings. METHODOLOGY: The TAS was conducted twice in each EU with TAS-1 and TAS-2 approximately 24 months apart. Lot quality assurance sampling (LQAS) formed the basis of the TAS survey design but specific EU characteristics defined the survey site (school or community), eligible population (6-7 year olds or 1(st)-2(nd) graders), survey type (systematic or cluster-sampling), target sample size, and critical cutoff (a statistically powered threshold below which transmission is expected to be no longer sustainable). The primary diagnostic tools were the immunochromatographic (ICT) test for W. bancrofti EUs and the BmR1 test (Brugia Rapid or PanLF) for Brugia spp. EUs. PRINCIPAL FINDINGS/CONCLUSIONS: In 10 of 11 EUs, the number of TAS-1 positive cases was below the critical cutoff, indicating that MDA could be stopped. The same results were found in the follow-up TAS-2, therefore, confirming the previous decision outcome. Sample sizes were highly sex and age-representative and closely matched the target value after factoring in estimates of non-participation. The TAS was determined to be a practical and effective evaluation tool for stopping MDA although its validity for longer-term post-MDA surveillance requires further investigation