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Berlin Brandenburg

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  • 1
    In: The New England Journal of Medicine, 2012, Vol.366(23), pp.2216-2221
    Description: A 29-year-old man presented with a 1-week history of fever, night sweats, reduced appetite, and left upper abdominal pain exacerbated by inspiration. He reported no weight loss, cough, dyspnea, nausea, diarrhea, rash, mouth ulcers, arthralgias, or ocular or urinary symptoms. ForewordIn this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows.StageA 29-year-old man presented to a local hospital with a 1-week history of intermittent fever, drenching night sweats, reduced appetite, and left upper abdominal pain exacerbated by inspiration. He reported no weight loss, cough, dyspnea, nausea, diarrhea, rash, mouth ulcers, arthralgias, or ocular or urinary symptoms. ResponseThis young patient presents with fever and abdominal pain. His prominent systemic symptoms and their short duration suggest infection until proved otherwise. Left upper abdominal pain that worsens on inspiration may be due to processes above or below the diaphragm. Bacterial and viral infections of the respiratory tract are common and may . . .
    Keywords: Medicine;
    ISSN: 0028-4793
    E-ISSN: 1533-4406
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  • 2
    In: Circulation, 2013, Vol.127(17), pp.1837-1839
    Description: An 82-year-old woman was transferred from her local hospital to our National Pulmonary Hypertension Service because of the suspicion of pulmonary hypertension. A month previously, she attended her local Accident & Emergency Department with a minor injury to her left leg. During triage an oxygen saturation of 85% was noted. She was cyanotic but she did not report any breathlessness, respiratory rate was in a normal range, and she was normotensive. On history she reported being limited when walking, which she considered normal for her age and she remained fully independent. Chest X-Ray (Figure 1) showed a large hernia that occupied central and right chest, raising suspicions of a Bochdalek hernia. High-resolution computed tomography and computed tomography pulmonary angiogram were performed and confirmed the presence of a large postero-lateral Bochdalek hernia with the stomach and portions of small and large bowel occupying a substantial portion of the right thoracic cavity and associated with right lung hypoplasia (Figure 2A–2D).There was no evidence …
    Keywords: Medicine ; Anatomy & Physiology;
    ISSN: 0009-7322
    E-ISSN: 15244539
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  • 3
    Language: English
    In: Science of the Total Environment, 01 April 2018, Vol.619-620, pp.391-400
    Description: The effects of sediment contamination on fish are of high significance for the protection of ecosystems, human health and economy. However, standardized sediment bioassays with benthic fish species, that mimic bioavailability of potentially toxic compounds and comply with the requirements of alternative test methods, are still scarce. In order to address this issue, embryos of the benthic European weatherfish ( ) were exposed to freeze-dried sediment (via sediment contact assays (SCA)) and sediment extracts (via acute fish embryo toxicity tests) varying in contamination level. The extracts were gained by accelerated solvent extraction with (i) acetone and (ii) pressurized hot water (PHWE) and subsequently analyzed for polycyclic aromatic hydrocarbons, polychlorinated biphenyls and polychlorinated dibenzodioxins and dibenzofurans. Furthermore, embryos of the predominately used zebrafish ( ) were exposed to extracts from the two most contaminated sediments. Results indicated sufficient robustness of weatherfish embryos towards varying test conditions and sensitivity towards relevant sediment-bound compounds. Furthermore, a compliance of effect concentrations derived from weatherfish embryos exposed to sediment extracts (96 h-LC ) with both measured gradient of sediment contamination and previously published results was observed. In comparison to zebrafish, weatherfish embryos showed higher sensitivity to the bioavailability-mimicking extracts from PHWE but lower sensitivity to extracts gained with acetone. SCAs conducted with weatherfish embryos revealed practical difficulties that prevented an implementation with three of four sediments tested. In summary, an application of weatherfish embryos, using bioassays with sediment extracts from PHWE might increase the ecological relevance of sediment toxicity testing: it allows investigations using benthic and temperate fish species considering both bioavailable contaminants and animal welfare concerns.
    Keywords: Acute Fish Embryo Toxicity Test ; Pressurized Hot Water Extraction ; Sediment Contact Assay ; Environmental Risk Assessment ; Alternative Test Method ; Early Life Stage ; Zebrafish ; Environmental Sciences ; Biology ; Public Health
    ISSN: 0048-9697
    E-ISSN: 1879-1026
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  • 4
    Language: English
    In: The New England Journal of Medicine, June 7, 2012, Vol.366(23), p.2216(6)
    Description: The article discusses the case of a 29-year-old man presented to a hospital with a 1-week history of intermittent fever, reduced appetite, and left upper abdominal pain exacerbated by inspiration to arrive at a better understanding of the symptoms, causes and diagnosis of systemic lupus erythematosus (SLE) and the hemophagocytic syndrome. The different treatment methodologies and management regime for SLE and the hemophagocytic syndrome are highlighted.
    Keywords: Systemic Lupus Erythematosus -- Causes Of ; Systemic Lupus Erythematosus -- Diagnosis ; Systemic Lupus Erythematosus -- Care And Treatment ; Systemic Lupus Erythematosus -- Case Studies
    ISSN: 0028-4793
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  • 5
    Language: English
    In: The American Journal of Cardiology, 15 January 2013, Vol.111(2), pp.278-285
    Description: Pulmonary hypertension (PH) in sarcoidosis is associated with bad outcomes. Although there is interest in using pulmonary vasodilators (PVs) for PH in sarcoidosis, there are few data to support their use. In this study, a retrospective review of a cohort of patients with PH and sarcoidosis was conducted, focusing on those treated with PVs, and a meta-analysis of published reports indexed in MEDLINE was performed. Twenty-four patients were found. The rate of mortality or transplantation rate was 41.2%. Median survival without transplantation was 5.3 years. More patients who died or underwent transplantation during follow-up had moderate or severe lung fibrosis (66.7% vs 15.4%), had right ventricular dysfunction (80% vs 7.7%), and were in World Health Organization class IV (66.7% vs 30.8%). Body surface areas were lower in patients with events, as was cardiac output. Mortality was not different between patients treated with PVs and those not treated (54.5% vs 38.5%, p = 0.44) despite the treated patients' having more right ventricular dysfunction and worse hemodynamics. In a Cox regression survival model, lower body surface area, right ventricular dysfunction, and the presence of moderate or severe lung fibrosis were predictors of worse outcomes, but not treatment with PVs. PV-treated patients (n = 11) showed improved 6-minute walk distances and decreased N-terminal pro–B-type natriuretic peptide levels during follow-up. There was a trend toward improvement in hemodynamic profile. Four studies plus the data from this study were included in the meta-analysis. Six-minute walk distance improved by 30.64 m after treatment. Hemodynamics improved, with a reduction in mean pulmonary arterial pressure of 8.03 mm Hg and a decrease in pulmonary vascular resistance of 4.23 Wood units. In conclusion, PH in sarcoidosis is associated with adverse outcomes, particularly when accompanied by right ventricular dysfunction and/or moderate or severe lung fibrosis. Treating selected patients can improve hemodynamics and functional parameters.
    Keywords: Medicine
    ISSN: 0002-9149
    E-ISSN: 1879-1913
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  • 6
    Language: English
    In: The Lancet, 2010, Vol.375(9721), pp.1203-1211
    Description: Sudden sensorineural hearing loss is usually unilateral and can be associated with tinnitus and vertigo. In most cases the cause is not identified, although various infective, vascular, and immune causes have been proposed. A careful examination is needed to exclude life threatening or treatable causes such as vascular events and malignant diseases, and patients should be referred urgently for further assessment. About half of patients completely recover, usually in about 2 weeks. Many treatments are used, including corticosteroids, antiviral drugs, and vasoactive and oxygen-based treatments. Although no treatment is proven, we recommend a short course of oral high-dose corticosteroids. There is much to learn about pathogenesis of sudden sensorineural hearing loss, and more clinical trials are needed to establish evidence-based management.
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
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  • 7
    Language: English
    In: Biophysical Journal, 02 February 2018, Vol.114(3), pp.165a-165a
    Keywords: Biology
    ISSN: 0006-3495
    E-ISSN: 1542-0086
    Source: ScienceDirect Journals (Elsevier)
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  • 8
    Language: English
    In: Arthritis & Rheumatism, April 2013, Vol.65(4), pp.1074-1084
    Description: To determine whether patients with systemic sclerosis (SSc) and borderline mean pulmonary artery pressure (PAP) at cardiac catheterization are more likely to develop pulmonary hypertension (PH) than those in whom pulmonary pressure is normal. Patients with SSc in whom PH and significant interstitial lung disease had been excluded at baseline were enrolled in our prospective cohort. Analysis of followup data identified patients who met prespecified criteria prompting repeat catheterization to reassess for possible PH. Using Kaplan-Meier, receiver operating characteristic, and Cox regression methods, we studied the development of PH and death. Of 228 patients in this study, 86 had borderline mean PAP (21-24 mm Hg) at baseline. Following prespecified criteria, 76 patients underwent repeat catheterization, and 29 of these developed PH. Two cases were related to disease of the left side of the heart. The average mean PAP increased from baseline (20.2 mm Hg) to followup (24.3 mm Hg) (P〈0.05 by Student's t-test). Patients with borderline mean PAP were more likely to develop PH than patients with mean PAP≤20 mm Hg (P〈0.001 by log rank test, hazard ratio [HR] 3.7). A transpulmonary gradient (TPG)≥11 mm Hg at baseline also predicted PH (P〈0.001 by log rank test, HR 7.9). Incident development of pulmonary arterial hypertension (PAH) was not benign, with a mortality of 18% within 3 years. Our findings indicate that borderline mean PAP and an elevated TPG in patients with SSc predict progression to PH. These patients should be monitored closely for the development of PH. Our findings indicate that catheterization data are useful in patients considered at risk of PAH.
    Keywords: Pulmonary Circulation ; Pulmonary Wedge Pressure ; Hypertension, Pulmonary -- Physiopathology ; Lung -- Blood Supply ; Pulmonary Artery -- Physiopathology ; Scleroderma, Systemic -- Physiopathology;
    ISSN: 0004-3591
    E-ISSN: 1529-0131
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  • 9
    Language: English
    In: Vaccine, 19 April 2017, Vol.35(17), pp.2127-2133
    Description: Vaccine exposure to temperatures below recommended ranges in the cold chain may decrease vaccine potency of freeze-sensitive vaccines leading to a loss of vaccine investments and potentially places children at risk of contracting vaccine preventable illnesses. This literature review is an update to one previously published in 2007 (Matthias et al., 2007), analyzing the prevalence of vaccine exposure to temperatures below recommendations throughout various segments of the cold chain. Overall, 45 studies included in this review assess temperature monitoring, of which 29 specifically assess ‘too cold’ temperatures. The storage segments alone were evaluated in 41 articles, 15 articles examined the transport segment and 4 studied outreach sessions. The sample size of the studies varied, ranging from one to 103 shipments and from three to 440 storage units. Among reviewed articles, the percentage of vaccine exposure to temperatures below recommended ranges during storage was 33% in wealthier countries and 37.1% in lower income countries. Vaccine exposure to temperatures below recommended ranges occurred during shipments in 38% of studies from higher income countries and 19.3% in lower income countries. This review highlights continuing issues of vaccine exposure to temperatures below recommended ranges during various segments of the cold chain. Studies monitoring the number of events vaccines are exposed to ‘too cold’ temperatures as well as the duration of these events are needed. Many reviewed studies emphasize the lack of knowledge of health workers regarding freeze damage of vaccines and how this has an effect on temperature monitoring. It is important to address this issue by educating vaccinators and cold chain staff to improve temperature maintenance and supply chain management, which will facilitate the distribution of potent vaccines to children.
    Keywords: Cold Chain ; Supply Chain ; Vaccine Freezing ; Temperature Monitoring ; Freeze-Sensitive Vaccine ; Training ; Medicine ; Biology ; Veterinary Medicine ; Pharmacy, Therapeutics, & Pharmacology
    ISSN: 0264-410X
    E-ISSN: 1873-2518
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  • 10
    Language: English
    In: Heart June 2017, Vol.103(Suppl 5), p.A89
    Description: Pulmonary arterial hypertension (PAH) is a rare cause of pulmonary hypertension (PH) with poor prognosis. Current guidelines recommend ventilation/perfusion (V/Q) scan in screening for thromboembolic cases of PH. We hypothesise that perfusion defects in non-thromboembolic PAH could also render abnormal V/Q scans, and sough to evaluate the incidence and clinical significance of abnormal V/Q SPECT in patients without thromboembolism.
    Keywords: Pulmonary Hypertension ; Spect ; Ventilation/Perfusion
    ISSN: 1355-6037
    ISSN: 13556037
    E-ISSN: 1468-201X
    E-ISSN: 1468201X
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