Impfungen unter immunsuppressiver Therapie chronisch entzündlicher Erkrankungen

Zusammenfassung: Chronisch entzündliche Krankheiten und immunsupprimierende bzw. -modulierende Therapien prädisponieren für häufigere und schwerer verlaufende Infektionen. Gewisse Infektionen können durch Impfungen verhindert werden. Unter Immunsuppression müssen die Indikation, das Impfansprechen und v.a. bei Lebendimpfstoffen mögliche Nebenwirkungen evaluiert werden. Am besten ist eine Impfung vor Beginn einer immunsupprimierenden Therapie, da dann Lebendimpfstoffe erlaubt sind und das immunologische Ansprechen besser ist. Patienten profitieren zusätzlich zu den Grundimmunisierungen von Impfungen gegen Influenza und Pneumokokken. Eine Verschlechterung der Grundkrankheit durch eine Impfung konnte in keiner kontrollierten Studie dokumentiert werde

Leading by Words: A Voluntary Contribution Experiment With One-Way Communication

In this paper, we study a voluntary contribution mechanism with one-way communication. The relevance of one person's words is assessed by assigning exogenously the role of the "communicator" to one group member. Contrary to the view that the mutual exchange of promises is necessary for the cooperation-enhancing effect of communication, we ï¬nd that, compared to a standard voluntary contribution mechanism with no communication, one-way communication signiï¬cantly increases contributions and renders them stable over time. Moreover, the positive effects of one-way communication persist even when communication is one-shot.Public goods experiment, Computer-mediated communication, Cheap-talk, Cooperation

A voluntary contribution experiment with one-way communication and income heterogeneity

One-way communication has been found to substantially increase contributions in linear voluntary contribution mechanisms. We confirm the robustness of this result in the presence of income heterogeneity.Public goods experiment, Cheap talk, Heterogeneous en- dowments

A voluntary contribution experiment with one-way communication and income heterogeneity

One-way communication has been found to substantially increase contributions in linear voluntary contribution mechanisms. We confirm the robustness of this result in the presence of income heterogeneity

Forest management intensity affects aquatic communities in artificial tree holes

Forest management could potentially affect organisms in all forest habitats. However, aquatic communities in water-filled tree-holes may be especially sensitive because of small population sizes, the risk of drought and potential dispersal limitation. We set up artificial tree holes in forest stands subject to different management intensities in two regions in Germany and assessed the influence of local environmental properties (tree-hole opening type, tree diameter, water volume and water temperature) as well as regional drivers (forest management intensity, tree-hole density) on tree-hole insect communities (not considering other organisms such as nematodes or rotifers), detritus content, oxygen and nutrient concentrations. In addition, we compared data from artificial tree holes with data from natural tree holes in the same area to evaluate the methodological approach of using tree-hole analogues. We found that forest management had strong effects on communities in artificial tree holes in both regions and across the season. Abundance and species richness declined, community composition shifted and detritus content declined with increasing forest management intensity. Environmental variables, such as tree-hole density and tree diameter partly explained these changes. However, dispersal limitation, indicated by effects of tree-hole density, generally showed rather weak impacts on communities. Artificial tree holes had higher water temperatures (on average 2° C higher) and oxygen concentrations (on average 25% higher) than natural tree holes. The abundance of organisms was higher but species richness was lower in artificial tree holes. Community composition differed between artificial and natural tree holes. Negative management effects were detectable in both tree-hole systems, despite their abiotic and biotic differences. Our results indicate that forest management has substantial and pervasive effects on tree-hole communities and may alter their structure and functioning. We furthermore conclude that artificial tree-hole analogues represent a useful experimental alternative to test effects of changes in forest management on natural communities.Fil: Petermann, Jana S.. University of Salzburg; Austria. Berlin-Brandenburg Institute of Advanced Biodiversity Research; AlemaniaFil: Rohland, Anja. Friedrich Schiller University; AlemaniaFil: Sichardt, Nora. Friedrich Schiller University; AlemaniaFil: Lade, Peggy. Friedrich Schiller University; AlemaniaFil: Guidetti, Brenda Yamile. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Friedrich Schiller University; AlemaniaFil: Weisser, Wolfgang W.. Friedrich Schiller University; Alemania. Technische Universität München; AlemaniaFil: Gossner, Martin M.. Friedrich Schiller University; Alemania. Technische Universität München; Alemani

44-jähriger Patient mit kulturnegativer, purulenter Perikarditis

Zusammenfassung: Wir berichten über einen Patienten mit purulenter Perikarditis und drohender Perikardtamponade, verursacht durch Neisseria meningitidis. Bei negativen Kulturen aus Blut und Perikardpunktat, wahrscheinlich bedingt durch die Vorbehandlung mit Antibiotika, konnten wir mittels Breitspektrumpolymerasekettenreaktion aus dem Perikardpunktat und einem Latexagglutinationstest aus Pleurapunktat Meningokokken der SerogruppeC nachweisen. Eine Meningokokkenperikarditis ohne Meningitis ist selten. Diagnostische Methoden auf nicht-kultureller Basis spielen bei Patienten, die bereits mit Antibiotika vorbehandelt sind, eine wichtige Roll

"Linkage to care" among people living with HIV - definition in the era of "universal test and treat" in a sub-Sahara African setting

BACKGROUND: Prompt linkage to human immunodeficiency virus (HIV) care after diagnosis is of utmost importance for individual health and reduction of HIV transmission. Different definitions for "linkage to care" have challenged comparisons as a public health marker. Its meaning in the era of "universal test and treat" has transformed in all settings, but is most relevant in sub-Sahara Africa, where the burden of new HIV infection is still highest. METHODS: For this narrative review on "linkage to care" definitions with a focus on sub-Saharan Africa, we searched PubMed/Medline between September and December 2020, restricted to the period 2000-2020 using Boolean operators: "HIV" AND ("linkage to care" OR "engagement in care") and screened for institutional definitions of "linkage to care". Additionally, as one example of a rural sub-Saharan African setting, we analysed linkage steps within the Chronic Diseases Clinic Ifakara (CDCI) and its associated Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) in rural Tanzania between 1 January 2017 and 31 March 2019. RESULTS: We analysed 81 articles that included "linkage to care" within different study settings and HIV organisations. Major differences in defining "linkage to care" exist, according to setting and location, patient populations and the timing of steps within the linkage process. We identified 16 different numerators and 10 denominators used to define linkage with time periods ranging from "same day as diagnosis" up to 12 months after diagnosis among 34 original articles from sub-Saharan Africa. At the CDCI, 1149/1671 (69%) newly diagnosed individuals were enrolled into care after diagnosis. Three months after enrolment into care, 94%, 86%, 85% and 71% of enrolled patients had a laboratory evaluation, a clinical evaluation, were initiated on treatment and had a first clinical follow-up visit after initiation of treatment, respectively. DUSCUSSION: To address the inconsistency in defining "linkage to care" and in order to guarantee the comparability of "linkage to care" in the sub-Saharan Africa region, we support the definition from the European region with some adaptions. We suggest a priority list of care indicators if more than one care indicator is available for successful "linkage to care" in the era of "universal test and treat" for sub-Sahara Africa

Persistent hiccups due to tuberculous meningitis in rural Tanzania – the value of Xpert testing in samples other than sputum

Tuberculous meningitis is the most severe form of extra-pulmonary tuberculosis and it has been associated with high mortality and morbidity. Clinical presentation of tuberculous meningitis varies, and the microbiological confirmation is usually difficult. We present two cases presented with persistent hiccups, miliary tuberculosis and tuberculous meningitis proven by positive Xpert® MTB/RIF assay in the cerebral spinal fluid. The first case improved after two weeks of treatment and completed treatment as an outpatient. The second case was discharged after three weeks of treatment after his condition improved and we learned from the relatives he died two weeks later at home

Hepatitis with Fibrin-Ring Granulomas

Abstract : We describe a 66-year-old woman hospitalized with fever, fatigue and hepatopathy. In her medical history arterial hypertension (treated with propranolol and lisinopril), diabetes mellitus type 2 (no treatment before admission) and a gout arthropathy were noted wherefore a therapy with allopurinol 300 mg per day has been started 4 months before. Liver biopsy revealed fibrin-ring granulomas, compatible with allopurinolinduced hepatitis. Because of persistence of high fever after stopping allopurinol, steroids (1 mg/kg) were started. Under this treatment, she developed pancytopenia and fever. The bone marrow aspiration revealed Leishmania infantum. A second liver biopsy showed amastigotes and a disappearance of the granulomas. The history revealed a travel to Malta 2 years earlier. Despite adequate treatment with liposomal amphotericin B the patient deteriorated and finally died in septic shoc