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Children’s and adolescents’ lives drastically changed during COVID lockdowns worldwide. To compare accident- and injury-related admissions to pediatric intensive care units (PICU) during the first German COVID lockdown with previous years, we conducted a retrospective multicenter study among 37 PICUs (21.5% of German PICU capacities). A total of 1444 admissions after accidents or injuries during the first lockdown period and matched periods of 2017–2019 were reported and standardized morbidity ratios (SMR) were calculated. Total PICU admissions due to accidents/injuries declined from an average of 366 to 346 (SMR 0.95 (CI 0.85–1.05)). Admissions with trauma increased from 196 to 212 (1.07 (0.93–1.23). Traffic accidents and school/kindergarten accidents decreased (0.77 (0.57–1.02 and 0.26 (0.05–0.75)), whereas household and leisure accidents increased (1.33 (1.06–1.66) and 1.34 (1.06–1.67)). Less neurosurgeries and more visceral surgeries were performed (0.69 (0.38–1.16) and 2.09 (1.19–3.39)). Non-accidental non-suicidal injuries declined (0.73 (0.42–1.17)). Suicide attempts increased in adolescent boys (1.38 (0.51–3.02)), but decreased in adolescent girls (0.56 (0.32–0.79)). In summary, changed trauma mechanisms entailed different surgeries compared to previous years. We found no evidence for an increase in child abuse cases requiring intensive care. The increase in suicide attempts among boys demands investigation.
Mucormycosis is an invasive fungal infection associated with high mortality, partly due to delayed diagnosis and inadequate empiric therapy. As fungal cultures often fail to grow Mucorales, identification of respective hyphae in tissue is frequently needed for diagnosis but may be challenging. We studied fluorescence in situ hybridization (FISH) targeting specific regions of the fungal ribosomal RNA (rRNA) of Mucorales to improve diagnosis of mucormycosis from tissue samples. We generated a probe combination specifically targeting Mucorales. Probe specificity was verified in silico and using cultivated fungi. Mucorales hyphae in tissue of a mouse model demonstrated a bright cytoplasmatic hybridization signal. In tissue samples of patients with mucormycosis, a positive signal was seen in 7 of 12 (58.3%) samples. However, autofluorescence in 3 of 7 (42.9%) samples impaired the diagnostic yield. Subsequent experiments suggested that availability of nutrients and antifungal therapy may impact on the FISH signal obtained with Mucorales hyphae. Diagnosis of mucormycosis from tissue might be improved by rRNA FISH in a limited number of cases only. FISH signals may reflect different wphysiological states of fungi in tissue. Further studies are needed to define the value of FISH to diagnose mucormycosis from other clinical samples.
Das Harnblasenkarzinom ist einer der häufigsten Tumoren weltweit. Insbesondere die muskelinvasiven Tumoren haben eine schlechte Prognose und stellen sich morphologisch sehr unterschiedlich dar. Diese Heterogenität wird bislang bei Therapieentscheidungen nicht beachtet. Um Patienten zukünftig individuell auf den vorliegenden Subtyp des muskelinvasiven Harnblasenkarzinoms (MIBC, muscle invasive bladder cancer) behandeln zu können und dadurch unnötige Belastungen durch Chemotherapien vermeiden zu können, ist eine einfache und kostengünstige Diagnostik erforderlich. Das Ziel der vorliegenden Arbeit war es, den Einsatz bestimmter immunhistochemischer Färbungen als ein mögliches diagnostisches Routineverfahren zur Bestimmung der vorliegenden Subtypen auszutesten. Hierzu wurde die Expression von „luminalen“ und „basalen“ Proteinen mit histologischen Subtypen des MIBCs korreliert. In einem zweiten Schritt wurde der Einfluss auf das Überleben mit und ohne adjuvante Chemotherapie untersucht.
Es wurden insgesamt 181 Tissue-Microarray-Spots analysiert. Alle histologischen Patientenproben sowie klinischen Daten stammten aus dem Universitätsklinikum Frankfurt am Main. Aus den entsprechenden Gewebeblöcken wurden Stanzen zur Erstellung eines Tissue-Microarrays (TMAs) entnommen. Diese wurden konventionell angeschnitten und histologisch mit Hämatoxylin-Eosin (H/E) sowie immunhistochemisch mit Cytokeratin 5/6 (CK5/6), Cytokeratin 20 (CK20), Glutamyl Aminotransferase-Untereinheit A bindendem Protein 3 (GATA3), Tumorsuppressor- protein p53 und Synaptophysin (SYNAPT) gefärbt.
Anhand der H/E-Schnitte wurden die vorliegenden histologischen Subtypen lichtmikroskopisch bestimmt und es folgte eine statistische Auswertung der Färbeergebnisse. Die deskriptive statistische Analyse zeigte insbesondere für die beiden Färbungen CK5/6 und GATA3 signifikante Ergebnisse. Deshalb wurden in einem zweiten Schritt alle Fälle der Studienkohorte den bekannten vier Gruppen: CK5/6 positiv, GATA3 positiv, doppelt positiv und doppelt negativ zugeordnet und näher untersucht. Es folgte eine Überlebensanalyse nach Kaplan Meier Schätzer sowie uni- und multivariate Analysen.
Die Ergebnisse zeigten eine Assoziation der Expression von CK5/6 mit einer squamösen Differenzierung (96%) und eine Assoziation der Expression von GATA3 mit einer mikropapillären Differenzierung (100%). Die adjuvante Chemotherapie ging mit einem Überlebensvorteil (HR 0,15 95%KI 0,1-0,3; p<0,001) der Patienten mit MIBC einher. Immunhistochemisch doppelt negative Patienten mit MIBC wiesen ein verringertes Gesamtüberleben auf (HR 4,96; 95%KI 1,6-15,6; p=0,006); in der Gruppe der doppelt negativen MIBCs fanden sich fünf verschiedene histologische Subtypen. Zusammenfassend lässt sich sagen, dass die immunhistochemische Klassifizierung des MIBCs mit histologischen Subtypen assoziiert ist und dabei helfen kann, Fälle in der pathologischen Routine in „luminal“ und „basal“ zu unterteilen. Jedoch ist ein auf zwei Markern basierendes Klassifizierungssystem nicht ausreichend, um die Heterogenität des MIBCs abzubilden und die Basis für Therapieentscheidungen zu bilden.
Background: High reproducibility and low intra- and interobserver variability are important strengths of cardiac magnetic resonance (CMR). In clinical practice a significant learning curve may however be observed. Basic CMR courses offer an average of 1.4 h dedicated to lecturing and demonstrating left ventricular (LV) function analysis. The purpose of this study was to evaluate the effect of initial teaching on complete and intermediate beginners’ quantitative measurements of LV volumes and function by CMR.
Methods: Standard clinical cine CMR sequences were acquired in 15 patients. Five observers (two complete beginners, one intermediate, two experienced) measured LV volumes. Before initial evaluation beginners read the SCMR guidelines on CMR analysis. After initial evaluation, beginners participated in a two-hour teaching session including cases and hands-on training, representative for most basic CMR courses, after which it is uncertain to what extent different centres provide continued teaching and feedback in-house. Dice Similarity Coefficient (DSC) assessed delineations. Agreement, accuracy, precision, repeatability and reliability were assessed by Bland-Altman, coefficient of variation, and intraclass correlation coefficient methods.
Results: Endocardial DSC improved after teaching (+0.14 ± 0.17;p < 0.001) for complete beginners. Low intraobserver variability was found before and after teaching, however with wide limits of agreement. Beginners underestimated volumes by up to 44 ml (EDV), 27 ml (ESV) and overestimated LVM by up to 53 g before teaching, improving to an underestimation of up to 9 ml (EDV), 7 ml (ESV) and an overestimation of up to 30 g (LVM) after teaching. For the intermediate beginner, however, accuracy was quite high already before teaching.
Conclusions: Initial teaching to complete beginners increases accuracy for assessment of LV volumes, however with high bias and low precision even after standardised teaching as offered in most basic CMR courses. Even though the intermediate beginner showed quite high accuracy already before teaching, precision did generally not improve after standardised teaching. To maintain CMR as a technique known for high accuracy and reproducibility and low intra- and inter-observer variability for quantitative measurements, internationally standardised training should be encouraged including high-quality feedback mechanisms. Objective measurements of training methods, training duration and, above all, quality of assessments are required.
Low-caloric formula diets can improve hemodynamic parameters of patients with type 2 diabetes. We, therefore, hypothesized that persons with overweight or obesity can benefit from a high-protein, low-glycemic but moderate-caloric formula diet. This post-hoc analysis of the Almased Concept against Overweight and Obesity and Related Health Risk- (ACOORH) trial investigated the impact of a lifestyle intervention combined with a formula diet (INT, n = 308) compared to a control group with lifestyle intervention alone (CON, n = 155) on hemodynamic parameters (systolic and diastolic blood pressure (SBP, DBP), resting heart rate (HR), and pulse wave velocity (PWV)) in high-risk individuals with prehypertension or hypertension. INT replaced meals during the first 6 months (1 week: 3 meals/day; 2–4 weeks: 2 meals/day; 5–26 weeks: 1 meal/day). Study duration was 12 months. From the starting cohort, 304 (68.3%, INT: n = 216; CON: n = 101) participants had a complete dataset. Compared to CON, INT significantly reduced more SBP (−7.3 mmHg 95% CI [−9.2; −5.3] vs. −3.3 mmHg [−5.9; −0.8], p < 0.049) and DBP (−3.7 mmHg [−4.9; −2.5] vs. −1.4 mmHg [−3.1; 0.2], p < 0.028) after 12 months. Compared to CON, INT showed a pronounced reduction in resting HR and PWV after 6 months but both lost significance after 12 months. Changes in SBP, DBP, and PWV were significantly associated positively with changes in body weight and fat mass (all p < 0.05) and resting HR correlated positively with fasting insulin (p < 0.001) after 12 months. Combining a lifestyle intervention with a high-protein and low-glycemic formula diet improves hemodynamic parameters to a greater extent than lifestyle intervention alone in high-risk individuals with overweight and obesity.
Soil-Transmitted Helminths (STH) is a group of nematodes that infect people and transmitted through soil media. STH occurs especially among pre-school and school-aged children, and commonly related to environmental sanitation and personal hygiene. The study objected to determine the factors related to the incidence of STH in children 5-15 years who lived surrounding the Sukawinatan district of Palembang city. The observational analytic using the cross-sectional design, consisted of 110 subjects sampled by consecutive sampling. Data on environmental sanitation and personal hygiene were obtained by questionnaires, while infection status using the Kato-Katz faecal technic. The results were analyzed using Chi-square test (α = 0.05), showed that 24.5% of population where infected with STH. A number of 1-24-2 children were infected with hookworm-Ascaris lumbricoides-Trichuris trichiura infection, respectively. Based on statistical test results, the association of STH infection with variables were: waste disposal (p = 0.268), water facilities (p = 1.000), sewage disposal (p = 0.224), latrine (p = 0.021), hand washing prior to meal (p = 0.001), hand washing after defecate (p = 0.028), use of footwear (p = 0.013), and nail hygiene (p = 1.000). Concluded that the significant factors related to STH were use of latrine, hand washing behaviour, and use of footwear. Further research will be necessary to successfully eliminate this neglected tropical disease.
Introduction Older patients with multimorbidity, polypharmacy and related complex care needs represent a growing proportion of the population and a challenge for healthcare systems. Particularly in transitional care (hospital admission and hospital discharge), medical errors, inappropriate treatment, patient concerns and lack of confidence in healthcare are major problems that may arise from a lack of information continuity. The aim of this study is to develop an intervention to improve informational continuity of care at the interface between general practice and hospital care.
Methods and analysis A qualitative approach will be used to develop our participatory intervention. Overall, 32 semistructured interviews with relevant stakeholders will be conducted and analysed. The stakeholders will include healthcare professionals from the outpatient setting (general practitioners, healthcare assistants, ambulatory care nurses) and the inpatient setting (clinical doctors, nurses, pharmacists, clinical information scientists) as well as patients and informal caregivers. At a series of workshops based on the results of the stakeholder analyses, we aim to develop a participatory intervention that will then be implemented in a subsequent pilot study. The same stakeholder groups will be invited for participation in the workshops.
Ethics and dissemination Ethical approval for this study was waived by the Ethics Committee of Goethe University Frankfurt because of the nature of the proposed study. Written informed consent will be obtained from all study participants prior to participation. Results will be tested in a pilot study and disseminated at (inter)national conferences and via publication in peer-reviewed journals.