1,720,977 research outputs found
Tuberculous meningitis in a renal transplant recipient
No full textTuberculous meningitis is a very rare, but serious extrapulmonary complication of mycobacterial infections in immunocompromised patients, such as organ transplant recipients. We describe here a 66-year-old Turkish woman without any history of tuberculosis, who received a renal allograft transplant in 1994. After a pilgrimage to an endemic area for tuberculosis, she presented with fever and headache in August 1998. Clinical examination revealed positive meningism and hyperreflexia. Lymphocytosis was noted in her cerebrospinal fluid (CSF) and Mycobacterium tuberculosis infection was detected by PCR within the CSF. Despite immediate triple antituberculosis therapy, the patient's clinical condition deteriorated rapidly, with the development of septic shock syndrome, and she died three weeks after admission due to cardiovascular and respiratory failure. Mycobacterial infections, including extrapulmonary manifestations, should thus be considered in all renal transplant recipients presenting with unexplained fever. Preventive therapy, i.e. isoniazid prophylaxis, may also be recommended for patients risking exposure in areas endemic for tuberculosis
Interactions of benzylpenicillin and non-steroidal anti-inflammatory drugs with the sodium-dependent dicarboxylate transporter NaDC-3
No full textSodium-dependent dicarboxylate transporters located in the basolateral membrane (NaDC-3) of renal proximal tubule cells maintain the driving force for exchange of organic anions and drugs against alpha-ketoglutarate via organic anion transporters OAT1 and OAT3. So far, information on direct interaction of drugs with the cloned NaDC-3 was missing. Here we tested the interaction of non-steroidal antiinflammatory drugs (NSAIDs) and benzylpenicillin with NaDC-3 cloned from winter flounder (fNaDC-3) and human (hNaDC-3) kidneys. Flufenamate and benzylpenicillin inhibited [C-14] succinate uptake in oocytes expressing fNaDC-3. Flufenamate elicited Na+-dependent currents in oocytes expressing fNaDC-3 with a reversal potential around -60 mV. Raising extracellular K+ concentration depolarized fNaDC3-expressing oocytes more in the presence of flufenamate than in its absence, an effect not seen with water-injected control oocytes. These findings suggest that flufenamate via interaction with fNaDC-3 increased the K+ conductance. Acetylsalicylate, indomethacin, and salicylate showed small potential-dependent inward currents in fNaDC-3 but not in hNaDC-3 expressing oocytes. Benzylpenicillin induced voltage-dependent inward currents which were Na+-dependent in oocytes expressing fNaDC-3. The currents were, however, much smaller than those induced by succinate, reflecting probably a low fit of the monovalent benzylpenicillin to the dicarboxylate binding site. The data show hitherto unknown effects of monovalent anionic drugs on a transporter for divalent di- and tricarboxylates. Copyright (C) 2004 S. Karger AG, Basel
Tuberculous meningitis in a renal transplant recipient
No full textTuberculous meningitis is a very rare, but serious extrapulmonary complication of mycobacterial infections in immunocompromised patients, such as organ transplant recipients. We describe here a 66-year-old Turkish woman without any history of tuberculosis, who received a renal allograft transplant in 1994. After a pilgrimage to an endemic area for tuberculosis, she presented with fever and headache in August 1998. Clinical examination revealed positive meningism and hyperreflexia. Lymphocytosis was noted in her cerebrospinal fluid (CSF) and Mycobacterium tuberculosis infection was detected by PCR within the CSF. Despite immediate triple antituberculosis therapy, the patient's clinical condition deteriorated rapidly, with the development of septic shock syndrome, and she died three weeks after admission due to cardiovascular and respiratory failure. Mycobacterial infections, including extrapulmonary manifestations, should thus be considered in all renal transplant recipients presenting with unexplained fever. Preventive therapy, i.e. isoniazid prophylaxis, may also be recommended for patients risking exposure in areas endemic for tuberculosis
Noise exposure during alpine helicopter rescue operations
No full textObjectives: We estimated the noise exposure of crews working in alpine helicopter rescue systems. Methods: Noise levels of the the helicopters used (Alouette III, Alouette II 'Lama', Ecureuil and BK 117) were measured with a device according to class 2 DIN IEC 651. These data were combined with the flight data of the personnel to evaluate the equivalent noise level according to DIN 45645-2. Results and conclusions: While the risk to patients should be limited to temporary threshold shifts the crew members are regularly exposed to equivalent noise levels of >85 dB(A) and, therefore, are at risk of permanent threshold shifts. Consequences for crew fitness to fly and for noise prevention (crew and patients) are discussed
Cold exposure during helicopter rescue operations in the Western Alps
No full textObjective: The study evaluates exposure to the cold of personnel involved in helicopter rescue operations in an alpine environment. Methods: Rescue operations over a period of 15 months in the Oberwallis region (Switzerland) were analysed with special regard to the weather conditions, the locality and its altitude, and the duration. The equivalent chill temperature was estimated with two independent models. 'Mean exposure' as well as the 'worst-case situation' (based on maximum windspeed) were calculated. The results were evaluated according to the 'classic' Siple-Passel model, the more recent model of Danielsson, ISO 11079, ISO 9920, the German industrial standard DIN 33403.5, and the German government regulations for work in cold environments ('G21'). Results: The temperature models showed only marginal differences in chill temperature. Assuming 'worst-case conditions', the Siple-Passel model showed that 87.1 % of the operations occurred at chill temperatures >-30degreesC, 12.1% in the range of -30 to -45degreesC, and 0.8% at 5% risk, 6% with >50% risk and 1.8% with >95% risk. According to DIN 33403.5, 1.5% of the operations were performed at chill temperatures higher than cold class 1: 2.3% are class 1, 13.3% class 2, 34.7% class 3, 34.6% class 4 and 13.7% class 5. The maximum exposure times of DIN 33404.5 are exceeded in at least 0.5% of the missions. According to ISO 11079, clothing with 2.0 clo is sufficient in 40.2 and 23.9% of the operations [summer, required clothing insulation (IREQ) min. and IREQ neutr., respectively]. In winter the corresponding results are 0.3 and 0.0%. Duration of limited exposure is exceeded in 9.1 (IREQ min.) and 19.8% (IREQ neutr.) of the operations in summer and in 10.3 and 19.8% in winter. According to ISO 9920, ICL min. as well as ICL neutr. is exceeded in 100% in summer and winter operations. Conclusions: Alpine rescue operations are typical of a place of work in a cold-sometimes extremely cold-environment. Because of the limited time of exposure during the majority of the operations, the most important danger for rescue personnel is frostbite, although hypothermia cannot be excluded in cases of prolonged operations. Special advice to avoid the specific risks must be given to the crews and an examination by occupational medicine, e.g. according to 'Working in cold environments, G21' of the German Berufsgenossenschaften, is recommended. Recommendations for adequate clothing are given
Workload during cardiopulmonary resuscitation
No full textLay resuscitation is crucial for the survival of the patients with out-of-hospital cardiac arrest. Therefore, lay CPR should be a basic skill for everyone. With the growing proportion of retired people in the Western societies, CPR performed by people with preexisting diseases and at risk of cardiac events is expected to grow. There is little knowledge about the workload during CPR and the minimum workload capacity of the rescuer. Pulse frequency, oxygen uptake, and CO2 elimination were measured by telemetry, while CPR was performed using a manikin with digital equipment for the standardization of the procedure. The same parameters were measured during a standard exercise testing protocol (spiroergometry) on a bicycle to analyze the aerobic endurance range of the participants. Data from the resuscitation protocols were correlated with those from spiroergometry to establish a simple standard investigation procedure to check people at risk and to give minimum requirements to perform CPR in Watts/kg. The study consisted of two parts: 1 (n = 16) explored minimal workload cutoffs for the rescuer using the 1995 recommendations and 2 (n = 14) tested the latest 2010 guidelines to compare both recommendations. When tested according to the 1995 guidelines, heart frequency of rescuers increased from 83.0 bpm (+/- 11.3) at rest to 109.9 bpm (+/- 12.6; P = 0.0004). The newer 2010 guidelines increased the workload marginally more (n.s.). CPR can be performed by healthy people within the range of aerobic endurance. The minimal requirements for trainings are 1.6-1.8 W/kg body weight in standard cycling ergometry. People at risk should be trained very careful. Since there is no significant lower workload when following the 1995 recommendations, people at risk should be trained according to the latest recommendations. In the case of a real resuscitation, such trained individuals must additionally take into account any symptoms.Austrian Society for Alpine and Altitude Medicine (OGAHM
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Potential-dependent steady-state kinetics of a dicarboxylate transporter cloned from winter flounder kidney
No full textThe two-electrode voltage-clamp technique in combination with tracer uptake experiments was used to investigate the dependence of dicarboxylate transport kinetics on membrane potential in Xenopus laevis oocytes expressing the flounder renal high-affinity-type sodium dicarboxylate cotransporter (fNaDC-3). Steady-state succinate-dependent currents in the presence of Na+ were saturable with an apparent affinity constant for succinate, K-0.5,K-succ. of 60 muM. K-0,K-5.succ was independent of membrane potential, suggesting succinate binding at the surface of the fNaDC-3 protein. The maximal succinate-dependent current, DeltaI(max), increased with hyperpolarization, suggesting that the empty carrier may translocate net charge. Succinate-induccd currents showed sigmoidal dependence on Na+ concentration, and K-0.5,K-Na+ decreased with hyperpolarization, suggesting Na+ binding in an ion well. Lowering the external Na+ concentration to 20 mM increased K-0.5,K-succ approximately threefold. Succinate-induced currents were inhibited by Li+ with an K-i,K-Li+ of approximately 0.5 mM, and a Hill coefficient of below unity indicating the interaction of one Li+ ion with an inhibitory site at fNaDC-3
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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