Nosokomiale Harnwegsinfektionen des Erwachsenen

Zusammenfassung: 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 mit einschließen. 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 einfließe

A comparison of statistical and machine-learning approaches for spatiotemporal modeling of nitrogen dioxide across Switzerland

Land use regression modeling has commonly been used to model ambient air pollutant concentrations in environmental epidemiological studies. Recently, other statistical and machine-learning methods have also been applied to model air pollution, but their relative strengths and limitations have not been extensively investigated. In this study, we developed and compared land-use statistical and machine-learning models at annual, monthly and daily scales estimating ground-level NO2 concentrations across Switzerland (at high spatial resolution 100 × 100 m). Our study showed that the best model type varies with context, particularly with temporal resolution and training data size. Linear-regression-based models were useful in predicting long-term (annual, monthly) spatial distribution of NO2 and outperformed machine-learning models. However, linear-regression-based models were limited in representing short-term temporal variation even when predictor variables with temporal variability were provided. Machine-learning models showed high capability in predicting short-term temporal variation and outperformed linear-regression-based models for modeling NO2 variation at high temporal resolution (daily). However, the best performing models, XGBoost and LightGBM, constantly overfit on training data and may result in erratic patterns in the model-estimated concentration surfaces. Therefore, the temporal and spatial scale of the study is an important factor on which the choice of the suitable model type should be based and validation is required whatever approach is used

Mycobacterium-avium -Pneumonie bei HIV-negativem Patienten

Zusammenfassung: Ein 79-jähriger Patient mit kurativ behandeltem Lungenkarzinom wurde wegen Fieber, Atemnot und Husten zugewiesen. Eine Antibiotikatherapie zur Pneumoniebehandlung brachte keine Besserung, und radiologisch war die Pneumonie progredient. Ein Erreger konnte nicht gefunden werden. Erst unter einer Steroidtherapie bei vermuteter kryptogener Pneumonitis normalisierten sich die Entzündungszeichen und die Symptomatik war rückläufig. Nach 3-wöchiger Kultivierung konnten im Eintrittssputum Mycobacterium avium Complex (MAC) gefunden und eine MAC-Pneumonie diagnostiziert werde

Estimating the health benefits associated with a speed limit reduction to thirty kilometres per hour: a health impact assessment of noise and road traffic crashes for the Swiss city of Lausanne

Reductions of speed limits for road traffic are effective in reducing casualties, and are also increasingly promoted as an effective way to reduce noise exposure. The aim of this study was to estimate the health benefits of the implementation of 30 km/h speed limits in the city of Lausanne (136'077 inhabitants) under different scenarios addressing exposure to noise and road crashes. The study followed a standard methodology for quantitative health impact assessments to derive the number of attributable cases in relation to relevant outcomes. We compared a reference scenario (without any 30 km/h speed limits) to the current situation with partial speed limits and additional scenarios with further implementation of 30 km/h speed limits, including a whole city scenario. Compared to the reference scenario, noise reduction due to the current speed limit situation was estimated to annually prevent 1 cardiovascular death, 72 hospital admissions from cardiovascular disease, 17 incident diabetes cases, 1'127 individuals being highly annoyed and 918 individuals reporting sleep disturbances from noise. Health benefits from a reduction in road traffic crashes were less pronounced (1 severe injury and 4 minor injuries). The whole city speed reduction scenario more than doubled the annual benefits, and was the only scenario that contributed to a reduction in mortality from road traffic crashes (one death per two years). Implementing 30 km/h speed limits in a city yields health benefits due to reduction in road traffic crashes and noise exposure. We found that the benefit from noise reduction was more relevant than safety benefits

Atypisches Erythema induratum Bazin bei tuberkulöser Osteomyelitis

Zusammenfassung: 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 kan

Association between community noise and children's cognitive and behavioral development: a prospective cohort study

BACKGROUND: Noise exposure has been associated with adverse cognitive and behavioral outcomes in children, but evidence on longitudinal associations between community noise and child development in low- and middle-income countries is rare. We investigated associations between community noise and behavioral and cognitive development in preschool children in Sao Paulo. METHODS: We linked child development data from the Sao Paulo Western Region Birth Cohort with average (Lden) and night-time (Lnight) community noise exposure at children's home, estimated by means of a land use regression model using various predictors (roads, schools, greenness, residential and informal settlements). Outcomes were the Strengths and Difficulties Questionnaire (SDQ) and Regional Project on Child Development Indicators (PRIDI) at 3 years of age and the Child Behavior Checklist (CBCL) and International Development and Early Learning Assessment (IDELA) at 6 years of age. We investigated the relationship between noise exposure and development using cross-sectional and longitudinal regression models. RESULTS: Data from 3385 children at 3 years of age and 1546 children at 6 years of age were analysed. Mean Lden and Lnight levels were 70.3 dB and 61.2 dB, respectively. In cross-sectional analyses a 10 dB increase of Lden above 70 dB was associated with a 32% increase in the odds of borderline or abnormal SDQ total difficulties score (OR = 1.32, 95% CI: 1.04; 1.68) and 0.72 standard deviation (SD) increase in the CBCL total problems z-score (95% CI: 0.55; 0.88). No cross-sectional association was found for cognitive development. In longitudinal analyses, each 10 dB increase was associated with a 0.52 SD increase in behavioral problems (95% CI: 0.28; 0.77) and a 0.27 SD decrease in cognition (95%-CI: 0.55; 0.00). Results for Lnight above 60 dB were similar. DISCUSSION: Our findings suggest that community noise exposure above Lden of 70 dB and Lnight of 60 dB may impair behavioral and cognitive development of preschool children

Land use regression modelling of community noise in São Paulo, Brazil

Noise pollution has negative health consequences, which becomes increasingly relevant with rapid urbanization. In low- and middle-income countries research on health effects of noise is hampered by scarce exposure data and noise maps. In this study, we developed land use regression (LUR) models to assess spatial variability of community noise in the Western Region of Sao Paulo, Brazil.We measured outdoor noise levels continuously at 42 homes once or twice during one week in the summer and the winter season. These measurements were integrated with various geographic information system variables to develop LUR models for predicting average A-weighted (dB(A)) day-evening-night equivalent sound levels (Lden) and night sound levels (Lnight). A supervised mixed linear regression analysis was conducted to test potential noise predictors for various buffer sizes and distances between home and noise source.Noise exposure levels in the study area were high with a site average Lden of 69.3 dB(A) ranging from 60.3 to 82.3 dB(A), and a site average Lnight of 59.9 dB(A) ranging from 50.7 to 76.6 dB(A). LUR models had a good fit with a R(2) of 0.56 for Lden and 0.63 for Lnight in a leave-one-site-out cross validation. Main predictors of noise were the inverse distance to medium roads, count of educational facilities within a 400 m buffer, mean Normalized Difference Vegetation Index (NDVI) within a 100 m buffer, residential areas within a 50 m (Lden) or 25 m (Lnight) buffer and slum areas within a 400 m buffer. Our study suggests that LUR modelling with geographic predictor data is a promising and efficient approach for noise exposure assessment in low- and middle-income countries, where noise maps are not available

Pharmakokinetik systemischer, regionaler und lokaler Medikamente in der Therapie intraokularer Entzündungen

Zusammenfassung: In der Therapie intraokularer Entzündungen gibt es ein breites Spektrum entzündungshemmender Medikamente mit unterschiedlichen Wirkmechanismen. Die mit Abstand häufigste Anwendung finden Kortikosteroide. Die Mechanismen sind bei den meisten Medikamenten vor allem aus tierexperimentellen Studien recht gut verstanden. Schaut man sich demgegenüber die pharmakokinetische Evidenz dieser Medikamente am Auge an, so ist man überrascht, wie wenig fundierte Daten und Informationen es hierzu für das menschliche Auge im Allgemeinen und das entzündete Auge im Besonderen gibt. Denn es ist zu erwarten, dass die Bioverfügbarkeit eines Medikaments in einem entzündeten Auge durch die Schrankenstörung anders ist und schneller niedrigere intraokulare Wirkspiegel als in einem nicht entzündeten Auge durch den besseren Abtransport entstehen können. Dieser Beitrag soll einen aktuellen Überblick zu dieser Problematik und den aktuellen Kenntnisstand zunächst für Lokaltherapeutika, dann intravitreal/parabulbär verabreichte Medikamente und schließlich der immunsuppressiven Systemtherapie vermitteln