Human brucellosis in a nonendemic country: a report from Germany, 2002 and 2003

Human brucellosis has become a rare disease in Germany since the eradication of bovine and ovine/caprine brucellosis in this country. Therefore, most physicians are unfamiliar with the illnesses clinical presentation, diagnostic tools, and therapeutic strategies. This retrospective study was carried out to evaluate the epidemiological, clinical, and laboratory features of human brucellosis in Germany in the years 2002 and 2003. Thirty-one bacterial isolates from 30 patients sent to the German national reference laboratory were characterized using the genus-specific bcsp31 real-time PCR, the species-specific AMOS-PCR, and standard microbiological methods for the detection and identification of Brucella spp. The medical records of all patients with bacteriologically confirmed brucellosis were evaluated. All 31 isolates proved to be Brucella (30 Brucella melitensis and 1 Brucella suis). Most of the brucellosis patients were infected in endemic countries while visiting friends and relatives during their summer holidays. One case of laboratory-acquired infection was identified. Brucellosis was transmitted mainly by the consumption of contaminated unpasteurized milk or cheese from goats and sheep. The patients presented primarily with flu-like symptoms, i.e. fever, chills, sweating, headaches, arthralgia, and myalgia. In most cases, however, symptoms and signs of focal complications, e.g. spondylitis, endocarditis, and meningoencephalitis, predominated. The rate of complications was much higher than that in endemic countries, presumably as a result of diagnostic delay due to a low index of suspicion. In summary, physicians in nonendemic countries such as Germany must be aware of brucellosis being a possible cause of fever of unknown origin in immigrants and tourists travelling from endemic countries.     

Elongation of the internal carotid artery and abdominal aortic aneurysm: is there a relationship?

BACKGROUND: This study was undertaken to analyze whether there is a relationship between the elongation of the internal carotid artery (e-ICA) and abdominal aortic aneurysm (AAA). METHODS: Forty-three patients had concomitant evidence of an asymptomatic AAA and e-ICA: all of these patients underwent surgical AAA repair, while 25 (58.1%) also underwent surgical e-ICA correction. The 43 patients were compared with a control group of 141 e-ICA subjects with no AAA as regards to age, gender, risk factors and associated diseases. An operative specimen of the aneurysmal wall was obtained in 32 instances (74.2%); an operative specimen of the carotid wall was obtained in 100% of operations. RESULTS: The overall perioperative mortality rate was 0%. Patency of the revascularized ICA was assured in 100% of cases. The perioperative stroke risk rate was 0%. The perioperative morbidity rate for abdominal surgery was 6.9% (3/43). There were three late deaths: one patient died from a major stroke due to occlusion of the unoperated e-ICA. Degenerative dysplastic changes were observed in the tunica media in all carotid specimens; non-obstructive atherosclerotic intimal lesions were superimposed in a few cases. Histological features of "classic" AAA, i.e. thinning of the tunica media underlying the atherosclerotic plaque, were discovered in all but five aortic wall specimens. CONCLUSIONS: The association between e-ICA and AAA is stronger than one would expect from atherosclerosis alone and should not be ignored. A primary arterial disorder of the tunica media seems to lie at the basis of both conditions, so patients with e-ICA should be investigated and followed up for any occurrence of AAA and, vice versa, patients with AAA should be investigated for any presence of e-ICA. On the basis of the results obtained, surgical repair of both conditions is recommended in selected patients.     

Densiron 68 heavy silicone oil in the management of inferior retinal detachment recurrence: analysis on functional and anatomical outcomes and complications

AIM: To assess the efficacy and safety of a heavy silicone oil (Densiron 68) in the management of inferior retinal detachment recurrence. METHODS: A retrospective non-comparative consecutive case series study. Forty-nine cases of complex inferior retinal detachment were treated using Densiron 68 heavy silicone oil (HSO) as the endotamponade. Our main purpose was anatomic reattachment following Densiron 68 removal. Functional outcomes, rate of recurrences, the presence of inflammatory complications and intraocular pressure alterations were evaluated. RESULTS: Forty-nine patients affected by complex retinal re-detachment were recruited. The mean follow-up was 7.6 (±1.5) mo. The mean best corrected visual acuity after Densiron 68 removal was 0.95 logMAR, standard error (SE: 0.068). Retinal reattachment was 61.2% after first surgery and 81.6% after second surgery. Nineteen cases (38.8%) had recurrences when intraocular heavy silicon oil was in situ, 26.3% (5 cases) of which involved the inferior retina. CONCLUSION: Densiron 68 ef?ciently fills the inferior retinal periphery and might lower the risk of inferior proliferative vitreoretinopathy development, in particular after a standard silicon oil tamponade that reduces the proliferative process in the upper quadrants of the retina.     

Less-invasive off-pump ventricular assist device implantation in regional paravertebral analgesia

We describe the clinical course and treatment of a 58-year-old male with a primary cardiogenic shock, who underwent a minimally invasive off-pump ventricular-assist-device (VAD) implantation with the aid of paravertebral regional analgesia. He was extubated soon after the procedure, in the operating room, with the aim to reduce the right ventricle impairment. We illustrate how a minimally invasive implant may improve the clinical outcomes of VAD patients shortening their return time to active life.     

Race and ethnic variation in college students’ allostatic regulation of racism-related stress

Racism-related stress is thought to contribute to widespread race/ethnic health inequities via negative emotion and allostatic stress process up-regulation. Although prior studies document race-related stress and health correlations, due to methodological and technical limitations, they have been unable to directly test the stress-reactivity hypothesis in situ. Guided by theories of constructed emotion and allostasis, we developed a protocol using wearable sensors and daily surveys that allowed us to operationalize and time-couple self-reported racism-related experiences, negative emotions, and an independent biosignal of emotional arousal. We used data from 100 diverse young adults at a predominantly White college campus to assess racism-related stress reactivity using electrodermal activity (EDA), a biosignal of sympathetic nervous system activity. We find that racism-related experiences predict both increased negative emotion risk and heightened EDA, consistent with the proposed allostatic model of health and disease. Specific patterns varied across race/ethnic groups. For example, discrimination and rumination were associated with negative emotion for African American students, but only interpersonal discrimination predicted increased arousal via EDA. The pattern of results was more general for Latinx students, for whom interpersonal discrimination, vicarious racism exposure, and rumination significantly modulated arousal. As with Latinx students, African students were particularly responsive to vicarious racism while 1.5 generation Black students were generally not responsive to racism-related experiences. Overall, these findings provide support for allostasis-based theories of mental and physical health via a naturalistic assessment of the emotional and sympathetic nervous system responding to real-life social experiences.

Racism in the United States shapes interracial social interactions (1) and, mirroring society-wide trends in the racialization of American politics (2, 3), the situation may be worsening with rising racial animosity (4, 5). Consequently, racism-related stress is hypothesized to contribute to widespread minority health disparities (6) and Black/White mortality differentials on a scale sufficient to influence election outcomes (7). One possible explanation for these disparities is that race-related stress increases negative emotions and physiological wear and tear via modulation of the sympathetic-adrenal-medullary (SAM) axis, hypothalamic-pituitary-adrenal (HPA) axis, and immune system (8). Up-regulation of these systems, often referred to generically as “the stress process,” is the outcome of the brain’s predictive modeling and regulation of the body’s energetic needs, or allostasis (9). Here, race-related stress is thought to increase energy demands as the brain prepares the body to deal with threats by marshaling oxygen, glucose, and other energetic mediators (10). Consequently, researchers have argued that ongoing allostatic up-regulation of the autonomic and endocrine systems, combined with immune activity modulation, in response to racism-related threats is physiologically taxing and over time increases vulnerability to chronic disease (11, 12). For example, downstream physiological adaptions to a body energized on high alert are thought to increase risks for excess adiposity, hypertension, diabetes, and cardiovascular disease (13–15), traditionally the leading cause of death in the United States.Despite the theoretical importance of regulatory allostatic processes for understanding racial health inequities, racism-related physiological responding has not been directly measured in real time in the real world. Conducting these assessments is challenging because the timing of many socially mediated experiences, such as racism-related incidents, occur in “social time”; that is, they are dependent upon actions beyond the control of the individual, are largely unobserved, and are highly variable and stochastic. Acute physiological changes are thus responses to temporally variable stimuli and are modulated on precise time scales in the order of seconds (i.e., SAM) and minutes (i.e., HPA). Although systematic and metaanalytic reviews find evidence that discriminatory experiences are correlated with mental and physical health both early (6) and later in life (16), most studies are cross-sectional, retrospective, and rely on behavioral and psychological self-reports, even when employing temporally sensitive methodologies (17). Although a few recent studies in natural settings incorporating biomarkers consistent with models of allostasis have begun filtering into the literature (18), their measurement strategies are not time-synchronized with race-related experiences. These studies provide post hoc evidence of allostatic process modulation, but do not measure allostatic regulation concurrently as it transpires in situ.Our study was designed to address these limitations and to directly test allostatic modulation of the sympathetic component of the SAM response to racism-related stress. To these ends, we developed a prospective protocol capturing events throughout the day, including the timing of racism-related experiences of perceived interpersonal discrimination, rumination on racism, and vicarious racism exposure, as well as negative emotions. Our design also included a wearable device that continuously tracked SAM activity using an electrodermal activity (EDA) sensor, a direct measure of the sympathetic nervous system (SNS) division of the autonomic nervous system that indexes affective arousal. This approach facilitated approximate time-synchronization of racism-related experiences with the SNS-mediated first-stage allostatic stress-response pathway. We were therefore able to operationalize two key aspects of stress-response dynamics temporally coupled with racism-related stressors: Negative emotion and SNS arousal. To our knowledge, this study provides a temporally coregistered and ecologically embedded assessment of the dynamic links between race-related stressors, negative emotions, and the SAM-mediated SNS component of a stress response among individuals of diverse ethnic backgrounds.