Accuracy of Point-of-Care B-Line Lung Ultrasound in Comparison to NT-ProBNP for Screening Acute Heart Failure.

AIM: The objective of this pilot study was to determine the accuracy of point-of-care B-line lung ultrasound in comparison to NT Pro-BNP for screening acute heart failure. MATERIALS AND METHODS: An 8-zone lung ultrasound was performed by experienced sonographers in patients presenting with acute dyspnea in the ED. AHF was determined as the final diagnosis by 2 independent reviewers. RESULTS: Contrary to prior studies, B-line ultrasound in our study was highly specific, but moderately sensitive for identifying patients with AHF. There was a strong association between elevated NT-proBNP levels and an increased number of B-lines. CONCLUSION: In conclusion, point-of-care lung ultrasound is a helpful tool for ruling in or ruling out important differential diagnoses in ED patients with acute dyspnea.

Influence of spinopelvic parameters on non-operative treatment of lumbar spinal stenosis.

BACKGROUND: Non-operative treatment is widely accepted for early stages of lumbar spinal stenosis. In general, a trial of conservative treatment is recommended prior to surgery. OBJECTIVE: The influence of sagittal alignment on treatment outcomes remains unclear. METHODS: Twenty-five patients were included in this prospective study. All patients received repeated epidural injections and facet joint injections as well as physiotherapy during a one week hospitalization. Patient characteristics, VAS scores, COMI scores, ODI scores and SF-36 were assessed prior to and immediately after treatment as well as after six, twelve, and 26 weeks. Spinopelvic parameter measurements were performed. Outcome parameters were correlated to spinopelvic parameters. RESULTS: ODI and PCSS scores improved significantly up to three months follow-up. COMI score improved significantly over the entire follow-up. Back pain improvement at six weeks and three months follow-up correlated inversely with pelvic incidence. Sacral slope correlated significantly with ODI improvement immediately after therapy. Low lumbar lordosis also correlated significantly with ODI improvement at three months follow-up. CONCLUSIONS: Subjects with higher pelvic incidence reported significantly greater back pain improvements at three months follow-up. ODI improvements were higher for patients with high sacral slope immediately after treatment and for patients with a higher lumbar lordosis after three months. No influence of sagittal alignment was observed on leg pain or quality of life.

[Recognition of infections in elderly emergency patients]. / Erkennen von Infektionen beim älteren Notfallpatienten.

BACKGROUND: Elderly patients represent an increasing population in the emergency department (ED) and physicians often have to deal with multimorbidity and complexity. Infections are one of the major reasons for ED presentations of older patients and the main cause of mortality; however, infections are often difficult to diagnose in older patients. AIM: This article provides a review of important indicators for infections, diagnostic tools and limitations in elderly patients. MATERIAL AND METHODS: A literature search was carried out using PubMed in the period 1990-2015 and in addition own published data are presented. RESULTS AND CONCLUSION: Infections in the elderly are difficult to assess in the emergency department due to atypical symptoms. Even subtle changes need to be recognized. For the diagnosis of infections in older ED patients unspecific symptoms, vital parameters, laboratory parameters, including C-reactive protein (CRP) and procalcitonin levels, cognitive function and functionality of the patient need to be taken into account.

[Health care situation of patients with suspected sepsis in a German emergency department]. / Versorgungsprozesse von Patienten mit Verdacht auf Sepsis in einer deutschen Notaufnahme.

BACKGROUND: The in-hospital mortality of patients with severe sepsis and septic shock (ssss) is high. Of note, little is known about the health care situation of patients with sepsis in German emergency departments. The aim of the study was to analyze whether sepsis patients are treated according to current guidelines, to identify the treatment sites within the hospital and to evaluate the death rate of affected patients during index hospitalization. PATIENTS AND METHODS: In this single-centre, prospective and observational trial we analyzed consecutive patients with complaints of sepsis during August and September 2012. RESULTS: During the study period 151 patients presented with complaints of sepsis (age 68.3 ± 18 years, 54.3% men, 45% with ssss, in-hospital mortality of the overall cohort: 14.6%). The Surviving Sepsis Campaign three hour bundle (lactate, blood cultures, broad spectrum antibiotics, and volume) was carried out in 54.2% of patients with ssss. In case of ssss, broad spectrum antibiotics were initiated in the emergency department in 85.4%. Patients with ssss were admitted to wards with usual care in 67.2%, in 32.8% they were admitted to an intensive or intermediate care unit. The in-hospital mortality of patients with ssss during their index hospitalization was 27.8%. CONCLUSION: Despite the high in-hospital mortality rate, more than two thirds of the patients with ssss were admitted to wards with usual care. We call for action 1) to early identify affected patients, 2) to provide adequate risk stratification tools and 3) to realize an early disposition of patients to the appropriate care units.

Trace detection of oxygen--ionic liquids in gas sensor design.

This paper presents a novel electrochemical membrane sensor on basis of ionic liquids for trace analysis of oxygen in gaseous atmospheres. The faradaic response currents for the reduction of oxygen which were obtained by multiple-potential-step-chronoamperometry could be used for real time detection of oxygen down to concentrations of 30 ppm. The theoretical limit of detection was 5 ppm. The simple, non-expensive sensors varied in electrolyte composition and demonstrated a high sensitivity, a rapid response time and an excellent reproducibility at room temperature. Some of them were continuously used for at least one week and first results promise good long term stability. Voltammetric, impedance and oxygen detection studies at temperatures up to 200 °C (in the presence and absence of humidity and CO2) revealed also the limitations of certain ionic liquids for some electrochemical high temperature applications. Application areas of the developed sensors are control and analysis processes of non oxidative and oxygen free atmospheres.

Kava treatment in patients with anxiety.

In several clinical trials, mainly conducted with a dose of 300 mg kava extract per day, kava has been employed successfully for the treatment of anxiety disorders. The goal of the placebo-controlled double-blind outpatient trial was to obtain more information on the dosage range and efficacy of a kava special extract WS 1490 in patients with non-psychotic anxiety. 50 patients were treated with a daily dose of 3 x 50 mg WS 1490 during a 4-week treatment period followed by a 2-week safety observation phase. In the active treatment group, the total score of the Hamilton anxiety scale (primary efficacy variable), showed a therapeutically relevant reduction in anxiety versus placebo (more than 4 points). In the secondary variables studied, HAMA 'somatic and psychic anxiety' subscales, the Erlangen anxiety, tension and aggression scale (EAAS), the brief personality structure scale (KEPS), the adjective checklist (EWL 60-S) and clinical global impressions scale (CGI), a trend in favour of the active treatment was detectable. WS 1490 was well tolerated and showed a safety profile with no drug-related adverse events or post-study withdrawal symptoms. It can be concluded that the applied 150 mg WS 1490 per day is an effective and safe treatment of non-psychotic anxiety syndromes in the described population.