Moisture damage and fungal contamination in buildings are a massive health threat - a surgeon's perspective.

OBJECTIVES: Indoor air toxicity is of major public health concern due to the increase in humidity-induced indoor mould exposure and associated health changes. The objective is to present evidence for the causality of health threats and indoor mould exposure. METHODS: PubMed search on the following keywords: dampness, mould, indoor air quality, public health, dampness, and mould hypersensitivity syndrome, sick building syndrome, and building-related illness as well as information from the health authorities of Bavaria and North Rhine-Westphalia, the Center of Disease Control (CDC), World Health Organisation (WHO), and guidelines of professional societies. RESULTS: The guidelines of professional societies published in 2017 are decisive for the assessment of the impact of mould pollution caused by moisture damage on human health and for official regulations in Germany. Until 2017, a causal connection between moisture damage and mould exposure could usually only be established for pulmonary diseases. The health risk of fungal components is apparent as documented in the fungal priority pathogens list (FPPL) of the WHO. Since 2017, studies, especially in Scandinavia, have proved causality between moisture and mould exposure not only for pulmonary diseases but also for extrapulmonary diseases and symptoms. This was made possible by new test methods for determining the toxicity of fungal components in indoor air. Environmental medical syndromes, e.g., dampness and mould hypersensitivity syndrome (DMHS), sick building syndrome (SBS), building-related symptoms (BRS), and building-related illness (BRI), and fungal pathogens, e.g., Aspergillus fumigatus, pose a major threat to public health. CONCLUSION: There is evidence for the causality of moisture-induced indoor moulds and severe health threats in these buildings. According to these findings, it is no longer justifiable to ignore or trivialize the mould contamination induced by moisture damage and its effects on pulmonary and extrapulmonary diseases. The health and economic implications of these attitudes are clear.

Prophylaxis and treatment of acute and chronic postoperative inguinal pain (CPIP)-association of pain with compression neuropathy.

Can open inguinal hernia repair (OIHR) and tailored neurectomy (TN) be effective for prophylaxis of chronic postoperative inguinal hernia repair (CPIP) (I) and treatment of CPIP (II)? Patients with symptomatic primary inguinal hernia (I group 1) and secondary hernia with CPIP (II, groups 2-5) were investigated for postoperative complications and nerve damage. About, 98% of patients with OIHR with TN reported preoperative pain (I group 1, n = 388, recurrence rate 1%). There were 73 cases (II) of CPIP after laparoscopic inguinal hernia repair (LIHR) (group 2, n = 22), OIHR (group 3, n = 37), LIHR followed by OIHR/LIHR (group 4, n = 5) and OIHR followed by LIHR/OIHR (group 5, n = 9). The results were as follows: preoperative pain: 33-100%, recurrence rate 0-11% (II, groups 2-5), nerve damage 92-100% and persistent CPIP: n = 1 after trocar perforation of inguinal nerve elsewhere. OIHR is effective to avoid CPIP with compression neuropathy. This is the largest series of histological nerve damage in CPIP.

Relevancia de la liberación de endotoxinas inducida por antibióticos / Importance of antibiotics-induced endotoxin release

Endotoxin is a major cause of sepsis and organ failure in humans. Antibiotics, which are administrated to treat these severe infections, may release Endotoxin from the bacterial wall and may harm the patient. Penicillin-binding protein (PBP) 2-specific antibiotics, e.g., imipenem were considered to release less amounts of free Endotoxin than PBP 3-specific antibiotics, e.g., Ceftazidime. This effect has been contributed to an increased bactericidal activity of PBP 2-specific antibiotics and consecutive change in morphology of pathogens, enabling phagocytosis. Recent in vitro studies, however, were unable to repeat these results. The antibiotic-induced Endotoxin release may change with the type of pathogen and dosing of the antibiotic. In animal studies Endotoxin release did not show a correlation to the bactericidal effect in all experiments. Antibiotic-induced Endotoxin release and outcome was different with regard to animal models, location of infection, strains, pharmocodynamics and dosage of antibiotics. Bacteriostatic antibiotics, e.g., lincomycin and clindamycin, were able to induce Endotoxin release. In some studies imipenem caused either similar release of Endotoxin compared to ceftazidime or more compared to ciprofloxacin. Chemically modified tetracycline or combination of antibiotics prevented an increased Endotoxin release. In patients with urosepsis controversial results were observed when imipenem was compared to ceftazidime. In clinical observational studies or post-hoc analysis of a randomized clinical trial a differential release of Endotoxin after imipenem and cephalosporins has been reported. In conclusion, antibiotic-induced Endotoxin release may be clinically relevant. However, there are many interfering factors in clinical studies, which need to be addressed properly when analyzing studies on antibioticinduced Endotoxin release

La endotoxina es una de las causas principales de sepsis e insuficiencia multiorgánica en los seres humanos. Los antibióticos que se administran para tratar estas infecciones graves pueden liberar endotoxina de la pared bacteriana y afectar al paciente. Se consideraba que los antibióticos específicos de la proteína ligadora de penicilina (PLP) 2, por ejemplo, imipenem, liberaban menores cantidades de endotoxina libre que los antibióticos específicos de la PLP 3, como la ceftazidima. Este efecto contribuye al aumento de la actividad bactericida de los antibióticos específicos de la PLP 2, con los consiguientes cambios en la morfología de los patógenos, lo que posibilita la fagocitosis. Sin embargo, recientes estudios in vitro no pudieron repetir estos resultados. La liberación de endotoxina inducida por antibióticos puede cambiar con el tipo de patógeno y la dosificación del antibiótico. En estudios con animales, la liberación de endotoxina no se correlacionó con el efecto bactericida en todos los experimentos. La liberación de endotoxina inducida por antibióticos, así como los resultados, fue diferente según los modelos con animales, la localización de la infección, las cepas, la farmacodinamia y la dosificación del antibiótico. Los antibióticos bacteriostáticos, como lincomicina y clindamicina, indujeron la liberación de endotoxina. En algunos estudios la liberación de endotoxina inducida por imipenem fue similar a la causada por ceftazidima y mayor que la inducida por ciprofloxacina. Las tetraciclinas modificadas químicamente y la combinación de antibióticos evitaron el aumento en la liberación de endotoxinas. En pacientes con urosepsis se observaron resultados controvertidos al comparar imipenem con ceftazidima. En estudios clínicos de observación o en los análisis post hoc de ensayos clínicos aleatorizados se informaron diferencias en la liberación de endotoxina luego de la administración de imipenem y cefalosporinas. En conclusión, la liberación de endotoxina inducida por antibióticos podría ser clínicamente relevante. No obstante, en los estudios clínicos pueden interferir muchos factores que deben ser abordados debidamente cuando se analizan los estudios acerca de este tema.

Lunar phase does not influence surgical quality.

INTRODUCTION: 10.5% of the German population believes in the effects of lunar phase on disease. The topic is hot in German TV program. It is believed that at new moon the rate of bleeding complications is increased and operations during the waning phase of the moon would be best to avoid complications, pain and scaring. To our knowledge the effect of lunar phase has not been studied in ambulatory surgery. PATIENTS AND METHODS: 782 patients were evaluated for complications and perception of the personal health after herniotomy, haemorrhoidectomy and crossectomy with partial vein stripping with or without phlebectomy as part of a quality control study. A questionnaire has been sent out to the patients asking the patient to rate postoperative pain, pain medication, restriction of daily activity, mental health and emotion, status of complaints after the operation. RESULTS: In 782 patients (mean age 50 years) 866 operations were performed. There were no major complications and only in 3.71% minor complications (local bleeding, haematoma, inflammation, abscess, seroma, lymphatic fistula, dehiscence) were observed. The operations were equally distributed to the lunar phases. Complications and patient's subjective perception of pain, restriction of daily activity, mental health and emotion, status of complaints after the operation were not associated with a lunar phase. CONCLUSIONS: The hypothesis that lunar phase influences the outcome of ambulatory operations is not valid. With regard to the organization of operations in the hospital and the patient's uncertainty to decide the right time the lunar phase philosophy may have an socio-economic impact not yet understood.