Relevance of CT for the detection of septic foci: diagnostic performance in a retrospective cohort of medical intensive care patients.

AIM: To analyse the diagnostic yield of computed tomography (CT) in septic patients from a medical intensive care unit (ICU). MATERIALS AND METHODS: A full-text search of the department's radiological information system (RIS) retrieved 227 body CT examinations undertaken to search for a septic focus in 2018 from medical ICU patients. CT reports were categorised according to the identified foci. Clinical and laboratory information was gathered. Data were analysed statistically using descriptive statistics, diagnostic test quality criteria, binomial tests and chi-square test. RESULTS: A total of 227 CT examinations from 165 septic patients detected 264 foci, which were distributed as follows: 58.3% (n=154/264) chest, 26.5% (n=70/264) abdomen, 5.3% (n=14/264) genitourinary system, and 9.8% (n=26/264) other body regions. In 15.9% (n=36/227) no focus was identified on CT. Based on CT reports, 37.5% (n=99/264) of foci were graded as certain, 18.9% (n=50/264) as likely, and 15.9% (n=42/264) as possible infectious sources. Septic foci were detected using CT with 75.8% sensitivity (95% confidence interval [CI] 69.6-81.9%) and 59.46% specificity (95% CI 42.9-76.1%). The positive predictive value was 90.6% (95% CI 86-95.2%), with a negative predictive value of 32.4% (95% CI 21-43.8%). CONCLUSION: The present results confirm that body CT is a suitable rule-in test for septic patients in medical intensive care, although it cannot reliably rule out a septic focus. Follow-up CT examinations may reveal a septic source in the further course of a patient's hospital stay.

[Rectal bleeding in a 60-year-old woman under anticoagulation and platelet aggregation inhibition]. / Peranaler Blutabgang bei einer 60-jährigen Patientin unter Antikoagulation und Thrombozytenaggregationshemmung.

CASE REPORT: We report on a woman with lower gastrointestinal bleeding under effective oral anticoagulation with both phenprocoumon and apixaban (with intention to switch to the latter) as well as the antiplatelet agent acetylsalicylic acid for aortic bifurcation kissing stents after stent thrombosis. Our patient presented with weakness and rectal bleeding. Upon examination, she looked anemic and had sinus tachycardia (104 beats per minute). The digital rectal examination revealed bright red blood mixed with clots. We established the diagnosis of lower gastrointestinal bleeding that originated from angiodysplasia in the cecum. The patient was stabilized with fluid resuscitation and transfusion. The bleeding source was treated endoscopically. Phenprocoumon had already been stopped and apixaban was paused immediately. Further intervention regarding coagulation was not needed. CONCLUSIONS: Anticoagulation is an important risk factor for gastrointestinal bleeding. Switching from phenprocoumon (or warfarin) to a non-vitamin K oral anticoagulant (NOAC) should be monitored closely using the international normalized ratio. Apixaban or other NOAC are currently not approved for arterial stent thrombosis and there is no evidence for efficacy. Therefore, off-label use requires careful consideration of the risks and benefits.

Heavy metals in wet method coffee processing wastewater in Soconusco, Chiapas, Mexico.

One of the driving forces of the economy in southeast Mexico is agriculture. In Soconusco, Chiapas, coffee is one of the main agricultural products and is traded on the international market. Coffee grown in this region is processed using the wet method in order to be commercialized as green coffee. In the beneficio (coffee processing plant) water is an essential resource which is required in great quantities (Matuk et al., 1997; Sokolov, 2002) as it is used to separate good coffee berries from defective ones, as a method of transporting the coffee berries to the processing machinery, in the elimination of the berry husk from the coffee grains (pulping) and finally in the post-fermentation washing process. This process gives rise to one of the smoothest, high-quality coffees available (Zuluaga, 1989; Herrera, 2002). Currently, many producers in Soconusco are opting for ecological coffee production, which has, among its many criteria, human health and environmental protection (Pohlan, 2005). Furthermore, increasing concern during the past few years regarding the production of food that is free from contaminants such as heavy metals, and recent environmental policies in relation to aquatic ecosystem protection, have given rise to questions concerning the quality of water used in coffee processing, as well as pollutants produced by this agroindustry. Water used in the coffee processing plants originates from the main regional rivers whose hydrological basins stretch from the Sierra Madre mountain range down to the coastal plain. As well as providing water, these rivers also receive the wastewater produced during coffee processing (Sokolov, 2002).