The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Prevalence of plasmodium falciparum in active conflict areas of eastern Burma: a summary of cross-sectional data

Conflict and war have long been recognized as determinants of infectious disease risk. Re-emergence of epidemic sleeping sickness in sub-Saharan Africa since the 1970s has coincided with extensive civil conflict in affected regions. Sleeping sickness incidence has placed increasing pressure on the health resources of countries already burdened by malaria, HIV/AIDS, and tuberculosis. In areas of Sudan, the Democratic Republic of the Congo, and Angola, sleeping sickness occurs in epidemic proportions, and is the first or second greatest cause of mortality in some areas, ahead of HIV/AIDS. In Uganda, there is evidence of increasing spread and establishment of new foci in central districts. Conflict is an important determinant of sleeping sickness outbreaks, and has contributed to disease resurgence. This paper presents a review and characterization of the processes by which conflict has contributed to the occurrence of sleeping sickness in Africa. Conflict contributes to disease risk by affecting the transmission potential of sleeping sickness via economic impacts, degradation of health systems and services, internal displacement of populations, regional insecurity, and reduced access for humanitarian support. Particular focus is given to the case of sleeping sickness in south-eastern Uganda, where incidence increase is expected to continue. Disease intervention is constrained in regions with high insecurity; in these areas, political stabilization, localized deployment of health resources, increased administrative integration and national capacity are required to mitigate incidence. Conflict-related variables should be explicitly integrated into risk mapping and prioritization of targeted sleeping sickness research and mitigation initiatives.     

Prevalence of plasmodium falciparum in active conflict areas of eastern Burma: a summary of cross-sectional data

Background  

Burma records the highest number of malaria deaths in southeast Asia and may represent a reservoir of infection for its neighbors, but the burden of disease and magnitude of transmission among border populations of Burma remains unknown.     

Behaviour of 125I-fibrinogen and 131I-albumin in experimental galactosamine-induced hepatitis.

The turnover of 125I-labelled fibrinogen and 131I-labelled albumin was studied in the course of galactosamine-induced hepatitis in rabbits. In addition to galactosamine, some animals were treated with epsilon-aminocaproic acid (EACA) to inhibit the activation of the fibrinolytic system. The infusion of galactosamine and EACA caused generation of fibrin-rich microclots in the renal glomerular capillaries in seven out of 12 rabbits. Correspondingly, the incorporation of 125I-radioactivity into liver, spleen, and kidneys was pronounced in galactosamine- and EACA-treated rabbits compared with control animals treated with EACA. An acceleration of the 125I-fibrinogen elimination from the plasma was observed between eight and 12 hours after the start of the galactosamine infusion. The administration of heparin in addition to galactosamine and EACA prevented the occurrence of intravascular coagulation, but shortened the survival times of the animals because of bleeding into visceral organs. The elimination of 131I-albumin in plasma as well as the distribution of 131I-radioactivity in organs were similar in all the rabbits independent of the treatment with galactosamine, EACA, or heparin. The experiments indicate that, in addition to diminished synthesis of coagulation factors, disseminated intravascular coagulation is involved in galactosamine-induced hepatitis and contributes to the haemostatic disorder.     

Using data to design systems of care adults with chronic illness

Increased Medicare risk contracts led to rising concern with readmission rates among the senior population with chronic illness at Carondelet Health Network. Using readily available data, Carondelet providers and administrators created intervention and evaluation strategies to redesign chronic care services to reduce increased readmissions. The strategies showed health plans can develop such strategies without waiting for sophisticated information systems to be put in place.     

Wipe test for the detection of indoor allergens

BACKGROUND: The determination of house dust mite and cat allergens is a prerequisite for qualified assessment of exposure risk indoors. We describe the validation of integrated wipe tests comprising a porous sampling pin for the collection of settled house dust and an immunochemical test set-up for specific analysis of dust associated allergens. METHODS: Wipe tests comprised an immunochromatographic test system and a porous sampling pin for collecting dust by manually wiping a surface. Two different wipe tests were developed with specificity to cat allergen (Fel d 1) and to dust mite allergen (Der p 2/f 2). One-hundred and fifty on-site determinations for each of the allergens in 50 different households completed the field study to validate the analytical system. Reference analysis was based on collection of dust with a vacuum cleaner and analysis of dust associated allergens by ELISA. RESULTS: The wipe tests were found to produce semiquantitative results (class 0-3) on-site within 10 min of analysis time. For dust mite (cat) allergen the median of class 0-3 was 119 (263), 812 (844), 2708 (5670) and 8000 (56 800) ng/g dust, respectively. With respect to cut-off levels for dust mite (cat) allergens the clinical sensitivity was 62% (79%) and the clinical specificity was 94% (92%). CONCLUSIONS: The wipe tests proved to be a reliable tool for indoor allergen exposure screening, suitable for use even by untrained persons. This may have an impact on compliance with allergen avoidance measures.     

Facial expression recognition in people with medicated and unmedicated Parkinson's disease

Recognition of facial expressions of emotion was investigated in people with medicated and unmedicated Parkinson's disease (PD) and matched controls (unmedicated PD, n=16; medicated PD, n=20; controls, n=40). Participants in the medicated group showed some visual impairment (impaired contrast sensitivity) and performed less well on perception of unfamiliar face identity, but did not show significant deficits in the perception of sex, gaze direction, or familiar identity from the face. For both Parkinson's disease groups, there was evidence of impaired recognition of facial expressions in comparison to controls. These deficits were more consistently noted in the unmedicated group, who were also found to perform worse than the medicated group at recognising disgust from prototypical facial expressions, and at recognising anger and disgust in computer-manipulated images. Although both Parkinson's disease groups showed impairments of facial expression recognition, the consistently worse recognition of disgust in the unmedicated group is consistent with the hypothesis from previous studies that brain regions modulated by dopaminergic neurons are involved in the recognition of disgust.     

IgG therapy in autoimmune haemolytic anaemia of warm type

Summary Three patients with autoimmune haemolytic anaemia of warm type were treated with high doses of intravenous immunoglobulin (Sandoglobulin®). The therapy was ineffective in all three cases. The possible reasons for this therapeutic failure are discussed.Supported by the Deutsche Forschungsgemeinschaft (Mu 277/9-4)