Bundeswehr Joint Medical Service

OBJECTIVE: Due to the combination of local trauma, extracorporeal circulation (ECC), and pulmonary and myocardial reperfusion, cardiac surgery leads to substantial changes in the immune system and possibly to post-operative complications. Procedures without ECC, however, have failed to demonstrate clear advantages. We hypothesized that ECC is far less important in this context than the reperfusion/reventilation of the lung parenchyma and the surgical trauma. We therefore conducted a prospective observational study to compare immune reactions after cardiac operations with those after thoracic surgery. METHODS: Serum levels of pro-inflammatory interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-alpha as well as C-reactive protein (CRP), lipoprotein-binding protein (LBP) and procalcitonin (PCT) were measured pre-operatively (d0), at the end of the operation (dx), 6h after the operation (dx+), on the 1st (d1), 3rd (d3), and 5th (d5) post-operative days in 108 patients (pts) undergoing elective coronary artery bypass grafting (CAB) with ECC (n=42, CPB CAB), off-pump coronary artery bypass surgery (n=24, OP CAB) without ECC or thoracic surgery (n=42, TS). RESULTS: After cardiac surgery (CS), IL-6 and IL-8 increased and reached a maximum on dx+. IL-6 returned to baseline values at d3, whereas IL-8 remained elevated until d5. No difference was found between OP CAB and CPB CAB patients. In the TS patients, IL-6 increased later (dx+) and absolute levels were lower than in the CS patients. No increase in IL-8 was noted in the TS patients. Due to the high variation in the results obtained in all three groups, there was no significant change in TNF-alpha. A comparison of TS, OP CAB, and CPB CAB revealed that the CS patients had higher levels on d0, dx, d3, and d5. Serum levels of CRP, LBP, and IL-2R increased from dx+ to d5 in all groups and reached maximum values on d3. Whereas we found no difference in CRP and IL-2R between the groups, LBP levels were significantly higher from dx+ to d3 after OP CAB. PCT was elevated from dx+ to d3 in all pts. Similar levels were noted for the TS and OP CAB patients. The CPB CAB patients showed the highest levels. CONCLUSIONS: Surgical trauma and reperfusion injury appear to represent the predominant factors resulting in immunologic changes after cardiac surgery. Cardiopulmonary bypass (CPB) may be less important for immune response and acute-phase reactions than previously suspected. In addition, our data indicate a relationship between IL-6 synthesis and the degree of surgical trauma. IL-8 appears to be elevated only after cardiac surgery whereas PCT liberation depended on the use of ECC.

The incidence of cutaneous and mucocutaneous Leishmaniasis (CL/MCL) is increasing globally, also in Germany, although the cases are imported and still low in number. The current evidence for the different therapies has many limitations due to lack of sufficient studies on the different Leishmania species with differing virulence. So far there is no international gold standard for the optimal management. The aim of the German joint working group on Leishmaniasis, formed by the societies of Tropical Medicine (DTG), Chemotherapy (PEG) and Dermatology (DDG), was to establish a guideline for the diagnosis and treatment of CL and MCL in Germany, based on evidence (Medline search yielded 400 articles) and, where lacking, on consensus of the experts. As the clinical features do not necessarily reflect the involved Leishmania species and, as different parasite species and even geographically distinct strains of the same species may require different treatments or varying dosages or durations of therapy, the guidelines suggest for Germany to identify the underlying parasite prior to treatment. Because of relevant differences in prognosis and ensuing therapy species should be identified in i) New World CL/MCL (NWCL/ MCL) to distinguish between L. mexicana-complex and subgenus Viannia, ii) in suspected infections with L. mexicana-complex to distinguish from L. amazonensis, and iii) in Old World CL (OWCL) to distinguish between L. infantum and L. major, L. tropica, or L. aethiopica. A state-of-the-art diagnostic algorithm is presented. For recommendations on localized and systemic drug treatment and physical procedures, data from the accessible literature were adjusted according to the involved parasite species and a clinical differentiation into uncomplicated or complex lesions. Systemic therapy was strictly recommended for i) complex lesions (e. g. > 3 infected lesions, infections in functionally or cosmetically critical areas such as face or hands, presence of lymphangitis), ii) lesions refractory to therapy, iii) NWCL by the subgenus Viannia or by L. amazonensis, iv) in MCL and v) in recalcitrant, or disseminating or diffuse cutaneous courses. In e. g. infection with L. major it encompasses miltefosine, fluconazole and ketoconazole, while antimony or allopurinol were here considered second choice. Local therapy was considered appropriate for i) uncomplicated lesions of OWCL, ii) L. mexicana-complex and iii) pregnant women. In e. g. infection with L. major it encompasses perilesional antimony, combined with cryotherapy, paromomycin 15 %/in methylbenzethoniumchlorid 12 % and thermotherapy. The group also stated that there is an urgent need for improving the design and the way of publishing of clinical trials in leishmaniasis.

Early identification of Acanthamoeba in cerebrospinal fluid is mandatory to prevent fatal granulomatous amebic encephalitis. In the case presented here amebic trophozoites were detected in a routine cerebrospinal fluid sample. The antibiotic treatment and the apparently low virulence of this isolate were responsible for the benign progression of the infection.

The factory-based permethrin coating technique has only recently been developed. Consequently, no data are available on residual activity, laundering, and weathering resistance in impregnated battle dress uniforms (BDUs) worn under military deployment conditions, or on the cross-contamination potential of such uniforms. Herein, factory-impregnated BDUs worn-out during military deployment to Afghanistan were investigated for residual permethrin concentration, residual efficacy against arthropod vectors, and cross-contamination during laundering and storage. When compared with BDUs subjected to 50 defined washings using the U.S. Insect/Arthropod Repellent Fabric Treatment method, no significant differences in efficacy were observed against Aedes mosquitoes, but remaining knockdown activity in Ixodes ticks was significantly better in polymer-coated BDUs. BDUs impregnated by the polymer-coating method were found to be effective for the life of the uniform, ensuring protection of soldiers in the field from arthropod vectors, while causing less cross-contamination than those treated by the Insect/Arthropod Repellent Fabric Treatment method.

Purpose: In recent years, the measurement of heart rate variability (HRV) has gained ground even outside research settings in everyday clinical and outpatient practice and in health promotion. Methods: Using the search terms “heart rate variability”, “hrv” and “circadian”, a systematic review was carried out in the PubMed database to find original work that analysed the course of HRV parameters over a 24-h period. Results: A total of 26 original studies were found. Almost all the studies detected a circadian rhythm for the HRV parameters analysed. HRV increased during the night in particular and a nighttime peak during the second half of the night was identified. Conclusions: HRV follows a circadian rhythm. But until today, there isn′t any possibility to make quantitative statements about changes over the course of the day for planning short-term measurements. More qualitative studies must be carried in order to close this knowledge gaps.

Following the recent discovery of two Pandoravirus species in 2013, a previously described endocytobiont isolated from the inflamed eye of a patient with keratitis was subjected to whole-genome sequencing (WGS). Here, we present the complete genome sequence of a new Pandoravirus isolate.

BACKGROUND: Animal experiments and epidemiological studies suggest that pentachlorophenol (PCP) and gamma-hexachlorocyclohexane (lindane) should be classified as possible human carcinogens. In the past, both have had a variety of applications in the civilian and military sectors and in forestry. They have, e.g., been used to impregnate and treat uniforms and other fabrics and to control human lice. Animal experiments indicate that PCP in particular causes mutations and chromosome aberrations and thus DNA damage. Studies on whether or not this also applies to newer substances and especially to natural type I and type II pyrethroids still are not available. What is particularly lacking are data on the genotoxic effects of these substances on human target cells. Our study describes the genotoxic effects of PCP, lindane, transfluthrin, cyfluthrin, and natural pyrethrum on human mucosal cells of the inferior and middle nasal conchae. METHODS: Epithelial cells were isolated from nasal mucosa, which was removed in the surgical treatment of chronic sinusitis and nasal concha hyperplasia. After the cells had been tested for vitality using the trypan blue exclusion test, the short-term culture method was used. The material was incubated with PCP (0.3, 0.75, and 1.2 mmol), lindane (0.5, 0.75, and 1.0 mmol), transfluthrin (0.05, 0.1, 0.5, 0.75, and 1.0 mmol), cyfluthrin (0.05, 0.1, 0.5, 0.75, and 1.0 mmol), natural pyrethrum (0.001, 0.005, 0.01, 0.05, and 0.1 mmol), and N-methyl-N'-nitro-N-nitrosoguanidine for 60 minutes. Substance-induced DNA damage (single-strand and double-strand breaks) were determined using single-cell microgel electrophoresis. A fluorescence microscope was used together with an image processing system to analyze the results obtained. RESULTS: After exposure to all tested substances, a high percentage of the cells of the middle nasal concha in particular were found to have severely fragmented DNA as a result of strong genotoxic effects. Although the reaction of the cells of the inferior nasal concha was significantly less strong (p < 0.001), the tested substances were nevertheless found to have a notable genotoxic effect on these cells too. CONCLUSION: Our study strongly suggests that exposure to PCP, lindane, transfluthrin, cyfluthrin, and natural pyrethrum has a genotoxic effect on the epithelial cells of human nasal mucosa. In addition, we have shown that nasal structures differ in susceptibility to the various pesticides used in the tests. Thus, the study provides new evidence supporting the biological plausibility of PCP- and lindane-induced effects, thereby helping evaluate potential PCP- and lindane-induced mucous membrane carcinomas of these parts of the nose. In addition, our study shows that other substances that today are widely used for controlling pests have a considerable genotoxic effect on human target cells. The results obtained indicate the need for additional studies on the genotoxicity of these substances and their adverse effects on human health.

OBJECTIVE: The activity of the specific immune system and especially the function of T helper (TH) cells are reduced after cardiac surgery. This decrease is followed by an increase in TH2 cell activity and a delayed recovery of TH1 cell function (TH1/TH2 shift). Neither the underlying cause nor the relationship between the absolute numbers of T lymphocyte subpopulations, the state of activation of these cells and cytokine synthesis in cell culture has been clarified. We conducted a prospective study in order to test the hypothesis that the decrease in specific immunity is not caused by dilution effects but by functional alterations in T cell subsets. METHODS: Blood samples were obtained from 40 patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB) preoperatively (d0), immediately after surgery (dx), and on the 1st (d1), 3rd (d3) and 5th (d5) postoperative days. The samples were stimulated for 24h with staphylococcal enterotoxin B and lipopolysaccharide. Interferon (IFN)-gamma, interleukin (IL)-2, IL-4, and IL-5 concentrations were measured by flow cytometry using a cytokine bead array kit. We determined white blood cell counts, analysed lymphocyte populations, and assayed human leukocyte antigen (HLA)-DR expression on cluster of differentiation (CD)4+ and CD8+ lymphocytes. Cytokine concentrations were corrected to preoperative absolute numbers of T helper cells. RESULTS: Leukocyte counts were elevated during the entire postoperative course with a maximum on dx. Absolute lymphocyte counts and especially the T cell subpopulations significantly increased immediately after surgery, then decreased to a minimum on d1 and increased again until they returned to preoperative levels on d3. The release of IFN-gamma, IL-2 and IL-4 was significantly reduced from dx to d5 with a minimum on d1. IL-5 was significantly reduced on dx and d1. When the concentrations were corrected to preoperative TH lymphocyte levels, IL-2 and IL-5 synthesis was significantly reduced only on dx and IL-4 release only on dx and d1. By contrast, IFN-gamma synthesis decreased postoperatively and remained suppressed until d5 with a minimum on d1. Only on d1 did an increase in HLA-DR expression give evidence of a change in the state of TH cell activation. CONCLUSIONS: The number of immune cells of the specific and the non-specific immune system is not reduced in the immediate postoperative period. Haemodilution thus has no detectable effect on immune function at this time point. Beginning on d1, the function of specific immune cells, especially TH lymphocytes, is severely suppressed. This functional alteration appears not to be preceded by T cell activation during CPB. Although TH cell activity begins to increase on d1, cytokine synthesis is reduced. When cytokine synthesis is corrected to the absolute number of TH cells in culture, there is strong evidence for an increase in TH2 cell activity. On the whole, these results corroborate the hypothesis of a TH1/TH2 shift that is primarily caused by an alteration of TH1 function. Neither haemodilution nor a preceding activation plays a major role.

The strong and consistent relationship between irradiation at a young age and subsequent thyroid cancer provides an excellent model for studying radiation carcinogenesis in humans. We thus evaluated differential gene expression in thyroid tissue in relation to iodine-131 (I-131) doses received from the Chernobyl accident. Sixty three of 104 papillary thyroid cancers diagnosed between 1998 and 2008 in the Ukrainian-American cohort with individual I-131 thyroid dose estimates had paired RNA specimens from fresh frozen tumor (T) and normal (N) tissue provided by the Chernobyl Tissue Bank and satisfied quality control criteria. We first hybridized 32 randomly allocated RNA specimen pairs (T/N) on 64 whole genome microarrays (Agilent, 4×44 K). Associations of differential gene expression (log(2)(T/N)) with dose were assessed using Kruskall-Wallis and trend tests in linear mixed regression models. While none of the genes withstood correction for the false discovery rate, we selected 75 genes with a priori evidence or P kruskall/P trend <0.0005 for validation by qRT-PCR on the remaining 31 RNA specimen pairs (T/N). The qRT-PCR data were analyzed using linear mixed regression models that included radiation dose as a categorical or ordinal variable. Eleven of 75 qRT-PCR assayed genes (ACVR2A, AJAP1, CA12, CDK12, FAM38A, GALNT7, LMO3, MTA1, SLC19A1, SLC43A3, ZNF493) were confirmed to have a statistically significant differential dose-expression relationship. Our study is among the first to provide direct human data on long term differential gene expression in relation to individual I-131 doses and to identify a set of genes potentially important in radiation carcinogenesis.

// Manuela A. Hoffmann 1, 2, 3 , Matthias Miederer 2 , Helmut J. Wieler 3 , Christian Ruf 4 , Frank M. Jakobs 5 and Mathias Schreckenberger 2 1 Supervisory Center for Medical Radiation Protection, Bundeswehr Medical Service Headquarters, Koblenz, Germany 2 Department of Nuclear Medicine, Johannes Gutenberg-University, Mainz, Germany 3 Department of Nuclear Medicine, Bundeswehr Central Hospital, Koblenz, Germany 4 Department of Urology, Bundeswehr Central Hospital, Koblenz, Germany 5 Department of Epidemiology, German Air Force Center for Aerospace Medicine, F&uuml;rstenfeldbruck, Germany Correspondence to: Manuela A. Hoffmann, email: manuhoffmann@web.de Keywords: prostate cancer; positron emission tomography/computed tomography; prostate-specific membrane antigen; choline; detection of significant cancer Received: August 16, 2017&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Accepted: October 27, 2017&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Published: November 14, 2017 ABSTRACT Background : Radiolabeled prostate-specific membrane antigen (PSMA) has proven to be a highly accurate method to detect recurrence and metastases of prostate cancer, but only sparse data is available about its performance in the diagnosis of clinically significant primary prostate cancer. Methods : We compared 68 Ga-PSMA-11 PET/CT in 25 patients with 18 FEC PET/CT in 40 patients with suspected prostate carcinoma based on an increased PSA level. The PET/CT results were compared with the histopathologic Gleason Score (GS) of biopsies. Results : The 68 Ga-PSMA-11 PET/CT revealed highly suspect prostatic lesions (maximum standardized uptake value/SUV max &gt;2.5) in 21/25 patients (84%), associated with GS&ge;6 (low-grade/high-grade carcinoma). Two histopathologic non-malignancy-relevant cases (GS&lt;6) had PSMA-SUV max &le;2.5; all histopathologic high-grade cases (GS&ge;7b) showed PSMA-SUV max &gt;12.0 which further increased with rising GS. There were 2 false positives and no false negative findings for high-grade prostate cancer using a cut off-level for SUV max of 2.5. In contrast, the 18 FEC PET/CT showed suspected malignant lesions in 38/40 patients (95%), which included 3 lesions with GS&lt;6. The mean SUV max values did not differ with different GS. There were 11 false positives and 1 false negative for detection of high-grade prostate cancer (cut off 2.5). By means of ROC analysis a SUV max of 5.4 was found to be an optimal cut off-level to distinguish between low- and high-grade carcinoma in 68 Ga-PSMA-11 PET/CT (AUC=0.9692; 95% CI 0.9086;1.0000;SD(AUC)=0.0309)). Choosing a cut off-level of SUV max 5.4, 68 Ga-PSMA-11 PET/CT was able to distinguish between GS &le;7a/&ge;7b with a sensitivity of 84%, a specificity of 100%, a negative predictive value (NPV) of 67%, and an efficiency of 88% ( p &lt;0.001). The ROC analysis revealed a SUV max 6.5 as an optimal cut off-level to distinguish between low- and high-grade carcinoma in 18 FEC PET/CT (AUC=0.7470; 95% CI 0.5919;0.9020;SD(AUC)=0.0791) with a sensitivity of 61% and a specificity of 92%; but the efficiency was only 70% and the NPV 50% ( p =0.01). Conclusion : 68 Ga-PSMA-11 PET/CT guided biopsy of the prostate increases diagnostic precision and is likely to help to reduce overtreatment of low-grade malignant disease as well as detect the foci of the highest Gleason pattern. Both methods ( 68 Ga-PSMA-11, 18 FEC) were suitable to detect primary prostate cancer, but the excellent image quality, the higher specificity and the good correlation of positive scans with GS are advantages of 68 Ga-PSMA-11.

Field investigations were conducted in Kundoz Province, an Afghan high-risk area, to determine factors responsible for the rapid reemergence of malaria in that country, where 3 million cases were estimated to have occurred during 2002. Results indicate the presence of nonrice-field-dependent Plasmodium falciparum and rice-field-associated P. vivax malaria.

BACKGROUND: Multidrug-resistant Klebsiella pneumoniae spp. (kp) are emerging agents of severe infections of the respiratory, urinary tract and wounds that can progress to fatal septicemia. The use of bacteriophages is currently being considered as an effective alternative or adjuvant to antibiotic therapy. RESULTS: In this study, we report capsule (K)-typing of 163 carbapenem-resistant Kp (CRKP) isolated 2014-2018 at the Military Hospital of Instruction of Tunis (MHT), Tunisia, by partial amplification and sequencing of the Kp wzi gene. The most prevalent K-type overall was K64 with 50.3% followed by K17 and K27 (22.7 and 11.0%, respectively). K64 Kp strains were most common and associated with increased case/fatality rates, especially at the intensive care unit (ICU). Using a K64 Kp strain we isolated and characterized a lytic Kp phage, vB_KpP_TUN1 (phage TUN1), from wastewater samples of the ICU at the MHT. TUN1 belongs to the Autographiviridae family and specifically digests K64 Kp capsules most probably via a depolymerase encoded by gp47. Furthermore, we successfully assembled phage TUN1 in a non-replicative host (E. coli) raising the possibility of in vitro assembly in the absence of live bacterial hosts. We propose that phage TUN1 is a promising candidate to be used as an adjuvant or an alternative to antibiotic therapy in CRKP infections, facilitating regulatory approval of phage therapy. CONCLUSIONS: K64, K17 and K27 are the most common wzi capsule types in this geographical location in Northern Africa. The lytic phage TUN1 efficiently lyses K64 Kp strains associated with increased case/fatality rates at body temperature. Together with its ability to be rescued in a non-replicative host these features enhance the utility of this phage as an antibacterial agent.

Introduction. Since 2013, European soldiers have been deployed on the European Union Training Mission (EUTM) in Mali. From the beginning, diarrhea has been among the most "urgent" concerns. Diarrhea surveillance based on deployable real-time PCR equipment was conducted between December 2013 and August 2014. Material and Methods. In total, 53 stool samples were obtained from 51 soldiers with acute diarrhea. Multiplex PCR panels comprised enteroinvasive bacteria, diarrhea-associated Escherichia coli (EPEC, ETEC, EAEC, and EIEC), enteropathogenic viruses, and protozoa. Noroviruses were characterized by sequencing. Cultural screening for Enterobacteriaceae with extended-spectrum beta-lactamases (ESBL) with subsequent repetitive sequence-based PCR (rep-PCR) typing was performed. Clinical information was assessed. Results. Positive PCR results for diarrhea-associated pathogens were detected in 43/53 samples, comprising EPEC (n = 21), ETEC (n = 19), EAEC (n = 15), Norovirus (n = 10), Shigella spp./EIEC (n = 6), Cryptosporidium parvum (n = 3), Giardia duodenalis (n = 2), Salmonella spp. (n = 1), Astrovirus (n = 1), Rotavirus (n = 1), and Sapovirus (n = 1). ESBL-positive Enterobacteriaceae were grown from 13 out of 48 samples. Simultaneous infections with several enteropathogenic agents were observed in 23 instances. Symptoms were mild to moderate. There were hints of autochthonous transmission. Conclusions. Multiplex real-time PCR proved to be suitable for diarrhea surveillance on deployment. Etiological attribution is challenging in cases of detection of multiple pathogens.

BACKGROUND: The main strategy to contain the current SARS-CoV-2 pandemic remains to implement a comprehensive testing, tracing and quarantining strategy until vaccination of the population is adequate. Scent dogs could support current testing strategies. METHODS: Ten dogs were trained for 8 days to detect SARS-CoV-2 infections in beta-propiolactone inactivated saliva samples. The subsequent cognitive transfer performance for the recognition of non-inactivated samples were tested on three different body fluids (saliva, urine, and sweat) in a randomised, double-blind controlled study. RESULTS: Dogs were tested on a total of 5242 randomised sample presentations. Dogs detected non-inactivated saliva samples with a diagnostic sensitivity of 84% (95% CI: 62.5-94.44%) and specificity of 95% (95% CI: 93.4-96%). In a subsequent experiment to compare the scent recognition between the three non-inactivated body fluids, diagnostic sensitivity and specificity were 95% (95% CI: 66.67-100%) and 98% (95% CI: 94.87-100%) for urine, 91% (95% CI: 71.43-100%) and 94% (95% CI: 90.91-97.78%) for sweat, 82% (95% CI: 64.29-95.24%), and 96% (95% CI: 94.95-98.9%) for saliva respectively. CONCLUSIONS: The scent cognitive transfer performance between inactivated and non-inactivated samples as well as between different sample materials indicates that global, specific SARS-CoV-2-associated volatile compounds are released across different body secretions, independently from the patient's symptoms. All tested body fluids appear to be similarly suited for reliable detection of SARS-CoV-2 infected individuals.

The use of radar technology for non-contact measurement of vital parameters is increasingly being examined in scientific studies. Based on a systematic literature search in the PubMed, German National Library, Austrian Library Network (Union Catalog), Swiss National Library and Common Library Network databases, the accuracy of heart rate and/or respiratory rate measurements by means of radar technology was analyzed. In 37% of the included studies on the measurement of the respiratory rate and in 48% of those on the measurement of the heart rate, the maximum deviation was 5%. For a tolerated deviation of 10%, the corresponding percentages were 85% and 87%, respectively. However, the quantitative comparability of the results available in the current literature is very limited due to a variety of variables. The elimination of the problem of confounding variables and the continuation of the tendency to focus on the algorithm applied will continue to constitute a central topic of radar-based vital parameter measurement. Promising fields of application of research can be found in particular in areas that require non-contact measurements. This includes infection events, emergency medicine, disaster situations and major catastrophic incidents.

An evaluation of physical fitness prior to employment appears to be mandatory for several occupations in order to protect the employee from overburdening and the employer from placing excess demands on the employee. One such occupation seems to be that of the field medical specialist who needs special physical strength since terrain conditions deny wheel-assisted transport of stretcher patients. The anthropometric and isometric force data of a total of 62 female and 48 male recruits for the medical service of the Bundeswehr were evaluated, together with their ability to carry a patient on a stretcher (weight = 14 kg) within a gymnasium. Initially the 'casualties' were simulated by sandbags weighing 60, 70, 80 and 90 kg each on stretchers; subsequently equivalent-weight water cans were used. The tests were administered at the beginning and at the end of the general Basic Military Training (BMT). While all males were able to carry the simulated 90 kg patient, only 22 out of 62 female recruits were able to do so at the beginning of BMT. At the end, the number had improved to 29 out of 55 women soldiers completing training. At the beginning of BMT 22.5% of the women soldiers were unable to rescue a simulated 70 kg patient; at the end of BMT the number had fallen to 18%. The isometric force values as measured revealed the hand grip strength as the best predictor for the capacity to carry simulated 90 kg patients. It is, therefore, suggested that a hand strength test be administered prior to field medical specialist training in order to channel unsuitable candidates into other training schemes.

Background: Testing of possibly infected individuals remains cornerstone of containing the spread of SARS-CoV-2. Detection dogs could contribute to mass screening. Previous research demonstrated canines' ability to detect SARS-CoV-2-infections but has not investigated if dogs can differentiate between COVID-19 and other virus infections. Methods: Twelve dogs were trained to detect SARS-CoV-2 positive samples. Three test scenarios were performed to evaluate their ability to discriminate SARS-CoV-2-infections from viral infections of a different aetiology. Naso- and oropharyngeal swab samples from individuals and samples from cell culture both infected with one of 15 viruses that may cause COVID-19-like symptoms were presented as distractors in a randomised, double-blind study. Dogs were either trained with SARS-CoV-2 positive saliva samples (test scenario I and II) or with supernatant from cell cultures (test scenario III). Results: When using swab samples from individuals infected with viruses other than SARS-CoV-2 as distractors (test scenario I), dogs detected swab samples from SARS-CoV-2-infected individuals with a mean diagnostic sensitivity of 73.8% (95% CI: 66.0–81.7%) and a specificity of 95.1% (95% CI: 92.6–97.7%). In test scenario II and III cell culture supernatant from cells infected with SARS-CoV-2, cells infected with other coronaviruses and non-infected cells were presented. Dogs achieved mean diagnostic sensitivities of 61.2% (95% CI: 50.7–71.6%, test scenario II) and 75.8% (95% CI: 53.0–98.5%, test scenario III), respectively. The diagnostic specificities were 90.9% (95% CI: 87.3–94.6%, test scenario II) and 90.2% (95% CI: 81.1–99.4%, test scenario III), respectively. Conclusion: In all three test scenarios the mean specificities were above 90% which indicates that dogs can distinguish SARS-CoV-2-infections from other viral infections. However, compared to earlier studies our scent dogs achieved lower diagnostic sensitivities. To deploy COVID-19 detection dogs as a reliable screening method it is therefore mandatory to include a variety of samples from different viral respiratory tract infections in dog training to ensure a successful discrimination process.

Suicidal ingestion of organophosphorus (OP) or carbamate (CM) compounds challenges health care systems worldwide, particularly in Southeast Asia. The diagnosis and treatment of OP or CM poisoning is traditionally based on the clinical appearance of the typical cholinergic toxidrome, e.g. miosis, salivation and bradycardia. Yet, clinical signs might be inconclusive or even misleading. A current case report highlights the importance of enzymatic assays to provide rapid information and support clinicians in diagnosis and rational clinical decision making. Furthermore, the differentiation between OP and CM poisoning seems important, as an oxime therapy will most probably not provide benefit in CM poisoning, but-as every pharmaceutical product-it might result in adverse effects. The early identification of the causing agent and the amount taken up in the body are helpful in planning of the therapeutic regimen including experimental strategies, e.g. the use of human blood products to facilitate scavenging of the toxic agent. Furthermore, the analysis of biotransformation products and antidote levels provides additional insights into the pathophysiology of OP or CM poisoning. In conclusion, cholinesterase activities and modern analytical methods help to provide a more effective treatment and a thorough understanding of individual cases of OP or CM poisoning.

Background: Iron deficiency is a common phenomenon in sports and may lead to impaired physical performance. The aim of the study was to determine the frequency of iron deficiency in competitive athletes and to discuss the resulting consequences. Methods: The data of 629 athletes (339 male, 290 female) who presented for their annual basic sports medicine examination were investigated. Depending on age (<14 years, 15−17 years, ≥18−30 years), four groups ((I.) normal hemoglobin (Hb) and ferritin level (≥30 ng/mL for adults and 15−18-year-olds; ≥20 ng/mL, respectively, ≥15 ng/mL for adolescents and children), (II.) prelatent iron deficiency (ID) (normal Hb, low ferritin), (III.) latent ID (additionally elevated soluble transferrin receptor or decreased transferrin saturation) and (IV.) manifest anemia) were distinguished. In addition, the iron status and exercise capacity of different types of sports were compared. Results: Overall we found an iron deficiency of 10.9% in male (mainly in adolescence) and 35.9% in female athletes (emphasized in adolescence and young adulthood). There were no significant differences in iron status in regard to the different sport types or in maximum performance for the different groups of iron deficiency. Conclusions: Adolescent and female athletes are more likely to have an iron deficiency. Therapy concepts for athletes therefore should pay attention to iron-rich diets.

INTRODUCTION: PTSD is associated with comprehensive disruption of several neurobiological regulation mechanisms and with a disruption in the parasympathetic-sympathetic balance. This can be measured with the heart rate variability (HRV). METHODS: A systematic review in PubMed using the keywords "hrv" or "heart rate variability" and "PTSD" or "posttraumatic stress disorder" was performed. RESULTS: Overall 15 original studies were identified. In most cases a significant relationship of PTSD for reduction of HRV was demonstrated (9 studies) or, respectively, a reduction by trends was shown in 3 studies. Limitations were discussed. DISCUSSION: In spite of the limitations, most of the studies have shown a relationship between PTSD and HRV. However, an assessment of this potential marker as a supplement for clinical diagnosis and therapy follow-up in patients with PTSD seems to be premature on the basis of the data obtained so far. Further research is required.