Risk factors for an infection with Coxiella burnetii in German sheep flocks.

In Germany, sheep are the main source of human Q fever epidemics, but data on Coxiella burnetii (C. burnetii) infections and related risk factors in the German sheep population remain scarce. In this cross-sectional study, a standardised interview was conducted across 71 exclusively sheep as well as mixed (sheep and goat) farms to identify animal and herd level risk factors associated with the detection of C. burnetii antibodies or pathogen-specific gene fragments via univariable and multivariable logistic regression analysis. Serum samples and genital swabs from adult males and females of 3367 small ruminants from 71 farms were collected and analysed using ELISA and qPCR, respectively. On animal level, univariable analysis identified young animals (<2 years of age; odds ratio (OR) 0.33; 95% confidence interval (CI) 0.13-0.83) to reduce the risk for seropositivity significantly (p < 0.05). The final multivariable logistic models identified lambing all year-round (OR 3.46/3.65; 95% CI 0.80-15.06/0.41-32.06) and purchases of sheep and goats (OR 13.61/22.99; 95% CI 2.86-64.64/2.21-239.42) as risk factors on herd level for C. burnetii infection detected via ELISA and qPCR, respectively.

Prevalence of Coxiella burnetii in German sheep flocks and evaluation of a novel approach to detect an infection via preputial swabs at herd-level.

A prevalence study was conducted on German sheep flocks including goats if they cohabitated with sheep. In addition, a novel approach was applied to identify an infection at the herd-level before lambing season with preputial swabs, suspecting venereal transmission and ensuing colonisation of preputial mucosa with Coxiella (C.) burnetii. Blood samples and genital swabs were collected from breeding males and females after the mating season and were analysed by enzyme-linked immunosorbent assay (ELISA) and quantitative polymerase chain reaction (qPCR) respectively. In total, 3367 animals were sampled across 71 flocks. The true herd-level prevalence adjusted for misclassification probabilities of the applied diagnostic tests using the Rogan-Gladen estimator for the prevalence estimate and a formula by Lang and Reiczigel (2014) for the confidence limits, ranged between 31.3% and 33% (95% confidence interval [95% CI] 17.3-45.5) detected by the ELISA and/or qPCR. Overall 26-36.6% (95% CI 13-56.8) were detected by ELISA, 13.9% (95% CI 4.5-23.2) by the qPCR and 7.9-11.2% (95% CI 0.08-22.3) by both tests simultaneously. The range of results is due to data obtained from literature with different specifications for test quality for ELISA. Among eight farms with females shedding C. burnetii, three farms (37.5%) could also be identified by preputial swabs from breeding sires. This indicates less reliability of preputial swabs if used as a single diagnostic tool to detect C. burnetii infection at the herd-level.

[Case fatality rate and outcome in multiply injured patients after trauma: influence of specialisation from the first treating physician - an analysis of 198 patients from a national trauma centre]. / Einfluss der Fachdisziplin des erstbehandelnden Notarztes auf das präklinische Management von Mehrfachverletzten - eine Auswertung von 198 Traumapatienten eines überregionalen Traumazentrums.

BACKGROUND: The treatment of multiple injured patients is a highly demanding process concerning the amount and speed of gathered information. Physicians have to evaluate the situation and begin a treatment immediately. There may be influencing variables in the pre-clinical treatment which are correlated to the specialisation of the first treating physician and influencing the outcome of the patient. The aim of this study was to examine the influence of the specialisation of the first treating physician on the pre-clinical treatment and the resulting outcome. PATIENTS AND METHODS: All trauma patients of our department from 2007 to 2010 who fulfilled the following criteria were included into our study: completely recorded DIVI-emergency protocol with declared specialisation of the first treating physician and inclusion into the trauma register of the DGU. This group of patients was divided into three groups according to the specialisation of the first treating physician (anaesthesia, surgery and other) and compared with one another. RESULTS: The study group consisted of 198 patients. 76 were treated by anaesthesiologists, 58 by surgeons, and 64 by physicians of other specialisations. The Injury Severity Score (ISS), the age and the distribution between the sexes showed no significant differences. Surgeons applied significantly less volume pre-clinically (794 ml [anesthesiologists: 1275 ml, others: 1231 ml; p value = 0.036]), the haemoglobin value was higher in the surgeon-treated group. This was also reflected in the applied blood transfusions at admission. The pre-clinical intubation rates (anaesthesiologists 48.7 %, others 37.5 %, surgeons 31 % [p value = 0.11]), the ventilator free days within the first 30 days after admission (anaesthesiologists 21.8, others 21.0, surgeons 25.8), intensive care unit free days within the first 30 days after admission (anaesthesiologists 18.4, others 18.5, surgeons 22.4) as well as the rescue time and case fatality rate showed no significant differences between the different groups. CONCLUSION: Multiply injured patients get a different treatment from the different specialised physicians in the pre-clinical phase. There were differences in the pre-clinical applied volume and haemoglobin value. Rescue time and intubation rate as well as outcome parameters were not statistically different. The case fatality rate in total was not significantly different between the 3 groups.

[The injured child--diagnostic work-up in the emergency room]. / Das verletzte Kind--diagnostisches Vorgehen im Schockraum.

The diagnosis of an injured child in the emergency room requires interdisciplinary collaboration and should be performed in a level 1 or 2 trauma center, if possible. Here, the basic trauma team could be complemented with (pediatric) surgeons. In a pediatric trauma center, specially trained pediatric surgeons or trauma surgeons, anesthetists, and radiologists who are experienced in the treatment of children should be available. The initial emergency room treatment does not differ significantly from that of adults. Ionizing radiation is the greatest hazard for children in the diagnosis of trauma patients. The CT scan is responsible for most of the radiation. To reduce the risk of developing a malignancy, the most harmful consequence of radiation, differentiated use is necessary. This can be achieved by using the presented algorithms. However, the differentiated use of the CT should not result in additional risk to the child. If the child is in a critical condition and obviously has multiple life-threatening injuries, the use of a whole-body CT is justified, due to time saving and targeted therapy of the child.

[Diagnostic management in paediatric blunt abdominal trauma - a systematic review with metaanalysis]. / Diagnostik des stumpfen Abdominaltraumas des Kindes - ein systematisches Review mit Metaanalyse.

OBJECTIVE: The objective of this systematic review was to investigate the diagnostic management in paediatric blunt abdominal injuries. METHODS: A literature research was performed using following sources: MEDLINE, Embase and Cochrane. Where it was possible a meta-analysis was performed. Furthermore the level of evidence for all publications was assigned. RESULTS: Indicators for intraabdominal injury (IAI) were elevated liver transaminases, abnormal abdominal examinations, low systolic blood pressure, reduced haematocrit and microhematuria. Detecting IAI with focused assessment with sonography for trauma (FAST) had an overall sensitivity of 56.5 %, a specificity of 94.68 %, a positive likelihood ratio of 10.63 and a negative likelihood ratio of 0.46. The accuracy was 84.02 %. Among haemodynamically unstable children the sensitivity and specificity were 100 %. The overall prevalence of IAI and negative CT was 0.19 %. The NPV of abdominal CT for diagnosing IAI was 99.8 %. The laparotomy rate in patients with isolated intraperitoneal fluid (IIF) in one location was 3.48 % and 56.52 % in patients with IIF in more than one location. CONCLUSIONS: FAST as an isolated tool in the diagnostics after blunt abdominal injury is very uncertain, because of the modest sensitivity. Discharging children after blunt abdominal trauma with a negative abdominal CT scan seems to be safe. When IIF is detected on CT scan, it depends on the number of locations involved. If IIF is found only in 1 location, IAI is uncommon, while IIF in two or more locations results in a high laparotomy rate.

[Intercultural differences in the treatment of severely injured patients with poor prognosis. Using the example of a 23-year-old Chinese patient]. / Interkulturelle Differenzen bei der Behandlung von schwerstverletzten Patienten mit infauster Prognose. Beispiel eines 23-jährigen chinesischen Patienten.

Because of globalization, we are increasingly confronted with the treatment of patients from other cultures. Using the example of a 23-year-old Chinese patient, we explain the origin of the intercultural differences which developed into a conflict.Due to a bicycle accident the patient incurred an extremely severe traumatic brain injury with multiple midface fractures. The prognosis was unfavorable. Despite extensive information the family insisted on maximum therapy. This resulted in a misunderstanding among the medical team involved, because they believed that this was not in the interests of the patient. The position of the family is rooted in Chinese culture. An intensive examination might have avoided, or at least mitigated, a conflict. To summarize, it could be useful to address cultural peculiarities at an early stage when treating patients from different cultures to prevent conflicts or to be better prepared for them. Also, an Ethics Commission may be involved early for preventing or resolving a potential conflict.

Special considerations in the interpretation of plain radiographs of the cervical spine in children. A review of the literature.

INTRODUCTION: This review provides an overview of the special considerations with regard to correct diagnosis of plain radiographs of the pediatric cervical spine. Injuries to the cervical spine are rare in children. The leading trauma mechanism is motor vehicle injury. Plain radiographs are a common tool in the search for a diagnosis. Taking the growth process into account there are many differences to be found compared to the adult c-spine. Knowledge of these differences is important when working towards the correct interpretation of plain radiographs of the pediatric c-spine. METHODS: To create this review, a literature search of the electronic databases Cochrane, PubMed/MEDLINE and Embase was conducted. RESULTS: Special considerations of plain radiographs of the pediatric c-spine are presented. Biomechanical and embryology specifics have been a focus of this review. They are explained relating on the development of the c-spine. The known auxiliary lines used in the interpreting of the pediatric c-spine are reported. A selection of these auxiliary lines is shown. CONCLUSION: Knowledge of the c-spines characteristics is of major importance for every physician involved in pediatric trauma care. This could lead to not only avoiding misdiagnosis but could also lead to avoiding the overuse of computed tomography of the pediatric c-spine.

Diagnosis of cervical spine injuries in children: a systematic review.

OBJECTIVE: The objective of this systematic review was to discuss current knowledge of the diagnostic management of cervical spine (c-spine) injuries in children. METHODS: Studies dealing with this topic were collected from the following sources: MEDLINE via PubMed, Embase, and Cochrane. Where possible, a meta-analysis was performed. Furthermore, the level of evidence for all the included publications was assigned. RESULTS: The incidence of cervical spine injury (CSI) in children is rare (1.39 %). It seems that the upper c-spine is more often injured in children younger than 8 years of age. When a CSI is expected, immobilization should be performed. The best immobilization is achieved with a combination of a half-spine board, rigid collar, and tape. The literature for thoracic elevation or an occipital recess in children younger than 8 years of age is inhomogeneous. The c-spine in children can be cleared by a combination of the National Emergency X-Radiography Utilization Study (NEXUS) low-risk criteria and the Canadian C-Spine Rule. Caution is advised for nonverbal and/or unconscious children. In these children, plain radiographs should be performed. If these images are inadequate or show hints for bony injuries, a computed tomography (CT) of the c-spine should be considered. Additional views of the c-spine offer only little information for clearing the c-spine.

Purification and characterization of TTFI, a factor that mediates termination of mouse ribosomal DNA transcription.

Termination of rRNA gene transcription is dependent on an 18-base-pair sequence motif, AGGTCGAC CAG AT TA NTCCG (the Sal box), which is present several times in the spacer region downstream of the 3' end of the pre-rRNA coding region. We report here the purification to molecular homogeneity of a nuclear factor which specifically interacts with the Sal box element. Addition of the isolated protein to S-100 extracts which contain low levels of the Sal box-binding protein and are therefore termination incompetent restores terminating activity, indicating that this protein is a polymerase I-specific transcription termination factor. The purified protein (termed TTFI) has a molecular weight of approximately 105,000 on sodium dodecyl sulfate-polyacrylamide gels. Mild proteolysis generates a relatively protease-resistant core which still specifically recognizes its target sequence. However, the termination activity has been lost, suggesting that the interaction with the DNA and the interaction with the transcription apparatus reside in different protein domains.

Evolutionary changes of sequences and factors that direct transcription termination of human and mouse ribsomal genes.

We have analyzed the sequences required for termination of human rDNA transcription. The human ribosomal transcription unit is shown to extend about 350 nucleotides into the 3'-terminal spacer and ends immediately upstream of a region with a distinct sequence heterogeneity. This heterogeneous region contains a cluster of conserved 10-base pair sequence elements which exert a striking homology to the proximal part of the 18-base pair murine rDNA transcription termination signal sequence, termed SalI box. Exonuclease III protection assays and in vitro transcription experiments with both homologous and heterologous human-mouse minigene constructs, and extracts from HeLa or Ehrlich ascites cells, reveal a functional analogy of the human sequence to the mouse SalI box. It mediates binding of a nuclear protein which functions as a transcription termination factor. The murine signal sequence is recognized by the human factor but not vice versa. The different sequence specificities and electrophoretic properties of the functionally equivalent protein factors suggest that a molecular coevolution has taken place between the termination signal sequences and the genes coding for the termination factors.