[Retrospective analysis of tuberculosis caused by Mycobacterium bovis 2004 - 2008]

BACKGROUND

mycobacterium bovis is a rare cause of tuberculosis in Germany. Epidemiological data are sparse.

METHODS

we have carried out a retrospective analysis of all patients diagnosed with tuberculosis caused by M. BOVIS in a pneumological referral centre between 2004 and 2008.

RESULTS

M. bovis was isolated in 8 out of 203 (3,9  %) patients with a new diagnosis of tuberculosis. The median age of these patients was 69 years, and 7 out of 8 showed risk factors for reactivation of a latent tuberculosis infection. In 4 patients (50  %) an extrapulmonary manifestation was present. All isolates of M. bovis were resistant to pyrazinamide, one isolate had an additional resistance to isoniazide. In 6 out of 8 patients prolonged tuberculostatic treatment of 8 - 12 months was recommended.

CONCLUSIONS

the proportion of tuberculosis caused by M. bovis was higher than that reported for Germany (3.9 vs. 1,5 %). Predominantly elderly patients with risk factors for reactivation of a latent tuberculosis infection were affected. In accordance with the literature a high rate of extrapulmonary manifestations was detected. Because of the genetic resistance of M. bovis to pyrazinamide prolonged antimycobacterial treatment is recommended.

Is the umbo matrix of bivalve shells (Laternula elliptica) a climate archive?

Heavy metal accumulation into bivalve soft tissues has received increasing interest in recent years with respect to biomonitoring of environmental change including pollution. To a lesser extent, accretion of elements from the environment into bivalve hard structures (shells) has been investigated, although the importance of the shells as environmental archives has been acknowledged. Here we report element distribution within consecutive growth bands in the shells of the Antarctic soft shell clam Laternula elliptica, which is currently exposed to vast environmental change in Antarctic Peninsula coastal environments that undergo rapid climate warming. We performed a high spatial resolution analysis for Al, Fe, Mn, Cu, Pb and U in the shell umbo, by means of laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS). Element ratios within the umbo did not resemble either the ratios in the surrounding seawater, the sedimenting material in Potter Cove, or even the Earth's crust basal composition. Mn and Cu were preferentially incorporated into the umbo. A strong decrease of element accretion with time could be related to lifetime respiration mass (R) of the animals. This indicates element accretion into the umbo and shell matrix to be largely a function of animal ecophysiology and life history, and these effects need to be considered in the context of potential usefulness of L. elliptica shells as environmental archives.

[Pulmonary nocardiosis with trimethoprime/sulphamethoxazole-resistant Nocardia paucivorans in a patient with no signs of immunosuppression]

This is so far the first published case report of a Nocardia paucivorans infection in an immunocompetent patient. A 54-year-old farmer was hospitalised with a history of coughing and fever for a period of five months. There was no indicator of either primary of secondary immunodeficiency in the prior medical history. A chest X-ray showed pneumonic infiltrates in the right middle und lower lobes, which progressed despite of antibiotic therapy with macrolides. A transbronchial biopsy revealed unspecific granulomatous inflammation of soft tissues. N. paucivorans - grew in cultures of sputum, bronchoalveolar lavage, and transbronchial biopsy. Oral antibiotic therapy was started with trimethoprime-sulphamethoxazole (TMP/SMX) and amoxicillin plus clavulanic acid. Susceptibility testing revealed high level resistance to TMP/SMX, which was consequently replaced by ciprofloxacin. Six months later, infiltrates had completely resolved and the patient did not report any residual clinical symptoms. The present case showed once again that nocardiosis is not limited to patients with immunodeficiencies. However, conservative combination therapy with oral antibiotics seems to be sufficiently effective for nocardiosis in the immunocompetent patient. For cases of suspected nocardiosis, a step-wise, risk-based diagnostic and therapeutic procedure is proposed.

Determination of the electron self-exchange rates of blue copper proteins by super-WEFT NMR spectroscopy

An NMR approach for determining the electron self-exchange (ESE) rate constants in blue copper proteins is presented. The approach uses the paramagnetic relaxation enhancement of resonances in 1D 1H super-WEFT spectra of partly oxidized (paramagnetic) proteins. These spectra allow a more precise determination of the relevant paramagnetic linebroadenings than conventional 1D 1H spectra and, thus, permit a more detailed investigation of the applicability of the linebroadenings for determining the electron exchange rates. The approach was used to estimate the ESE rate constant of plastocyanin from Anabaena variabilis. It was found that, although the rate constant can be determined accurately from a series of resonances, precise but erroneous constants are obtained from the resonances of the copper-bound residues, unless a narrow splitting of these resonances caused by the presence of two conformations is taken into account. As demonstrated here, this complication can be overcome by a correct analysis of the paramagnetic broadening of the combined double signals. Because of the high resolution and specific sensitivity of the approach it should be generally applicable to estimate electron transfer rates, k, if the paramagnetic relaxation enhancement R2p of the resonances can be determined, and the conditions k << R2p or delta omega(p) >> k >> R2p are fulfilled, delta omega(p) being the frequency separation between corresponding diamagnetic and paramagnetic sites.

The importance of intuition in the occupational medicine clinical consultation

Clinical consultation involves unspoken elements which flow between doctor and patient. They are vital ingredients of successful patient management but are not easily measured, objective or evidence-based. These elements include empathy and intuition for what the patient is experiencing and trying to express, or indeed suppressing. Time is needed to explore the instinctive feeling for what is important, particularly in present day society which increasingly recognizes the worth of psychosocial factors. This time should be available in the occupational health consultation. In this paper the importance of intuition and its essential value in the clinical interview are traced through history. Differences between intuition and empathy are explored and the use of intuition as a clinical tool is examined.

Cholecystokinin, gastrin and stress hormone responses in marathon runners

The purpose of this investigation was to determine the influence of long-distance running on the secretion of the gastrointestinal peptide hormones cholecystokinin (CCK) and gastrin. Several known stress hormones, ACTH, cortisol and norepinephrine, were also measured. The hormones were estimated before and after a competitive marathon run of 46.5 km and under control conditions a few weeks later. Except gastrin, all hormones were significantly higher under prerun conditions than under control conditions and were highest after the run. The most marked prerun elevation was in CCK. Therefore, CCK seems to be an important regulation factor in response to anticipatory stress.

Assay for tyrosine hydroxylase in hypothalamic homogenates using high-performance liquid chromatography with electrochemical detection

A highly sensitive and reliable assay for tyrosine hydroxylase (TH) activity in hypothalamic homogenates of male rats using high-performance liquid chromatography with electrochemical detection is described. Modification of sample preparation and chromatographic conditions led to a complete separation of L-3,4-dihydroxyphenylalanine (L-DOPA) and alpha-methyldopa from all interfering catecholamines and their metabolites. This assay is highly sensitive; 2 pmol of L-DOPA formed enzymatically could be measured. We were able to determine TH activity in tissue pieces weighing less than 1 mg. TH activity was not changed after storage for three months at -80 degrees C. In hypothalamic homogenates the Michaelis constant (KM) for L-tyrosine was 80.5 +/- 6.5 mumol/l and the maximal velocity (Vmax) was 132.5 +/- 10.5 pmol/mg of protein per min for L-DOPA formed enzymatically.

Effect of starvation on hypothalamic tyrosine hydroxylase activity in adult male rats

The activity of tyrosine hydroxylase (TH), the rate-limiting enzyme in norepinephrine synthesis, was determined in the mediobasal hypothalamus of adult male rats during acute and semistarvation. 3,4-Dihydroxyphenylalanine (DOPA) formed by TH was measured using high-performance liquid chromatography (HPLC). Acute starvation, as well as 3 weeks of semistarvation on a high-protein low-carbohydrate diet (CST PR) reduced TH activity significantly. Three weeks of a low-protein high-carbohydrate diet (CST KH) did not affect TH activity. While maximal velocity (Vmax) is significantly diminished in acute starvation and in semistarvation with a high-protein low-carbohydrate diet, Kd-values for tyrosine were not changed. These results suggest that TH activity in the brain contributes to decreased norepinephrine (NE) turnover in starvation.

Oral nafazatrom in man: effect on inhaled antigen challenge

The effect of oral nafazatrom (Bay g6575, 2 X 3 g) or placebo on inhaled antigen challenge was assessed in a double-blind study. In four subjects antigen challenge resulted in an immediate fall of 93.2 +/- 3.36% in airflow at 40% of vital capacity (Vp40) and a 45.85 +/- 4.95% reduction in forced partial expiratory volume at one second (FEV1). Neither nafazatrom nor placebo had any effect on baseline lung function or that after challenge. Leukotriene B4 was generated by ex vivo stimulus of blood with ionophore A23187, and quantified by high performance liquid chromatography (h.p.l.c.)-radioimmunoassay. No inhibition of LTB4 formation occurred ex vivo following oral nafazatrom, although addition of 10(-5) M nafazatrom to blood in vitro significantly inhibited LTB4 release. Peak plasma nafazatrom levels during the study ranged from 3.3 X 10(-7) M to 1.47 X 10(-6) M which are below the concentration (10(-5) M) at which significant 5-lipoxygenase inhibition occurs in vitro. Oral nafazatrom is ineffective as a 5-lipoxygenase inhibitor in man, probably because of poor bioavailability after administration.

Can children's paintings of their doctors be interpreted?

There is increased emphasis nowadays on the role of the general practitioner in preventive care for children. Accordingly, an analysis of the child's perception of the doctor and of the factors which influence and mould that perception are important. In New Zealand children's paintings have been used for such analyses. The present study looked at children's paintings of their family doctors in a Devonshire village. The findings show that boys are more likely than girls to depict their doctors as a gruesome or threatening character, and suggest that medical contact has little, if any, influence on character portrayal of doctors. Other factors that might influence character portrayal and are now thought worthy of detailed study, include television viewing patterns, personality, age, home background and artistic ability.

A clinical trial of nafazatrom (Bay g 6575) in advanced cancer

Nafazatrom (Bay g 6575) has been shown to be a potent inhibitor of tumor metastasis in preclinical models. It is believed to work by stimulating endogenous prostacyclin production. The drug has also been shown to inhibit the growth of certain experimental tumors, to be cytostatic for certain cell lines in tissue culture, and to induce differentiation in HL-60, neuroblastoma, and Friend erythroleukemia cell lines. Furthermore, no toxicity has been seen in animals or human volunteers. We report here a clinical trial of oral nafazatrom at five dose levels in patients with advanced cancer. Thirty patients with a wide variety of advanced malignancies were treated for 26-638+ days (median 82 days). No tumor responses were seen. Toxicity included two cases with mild skin rashes, one case with nausea and vomiting, and one case with diarrhea. Nafazatrom is a safe and well-tolerated agent. Maximum activity would be predicted to occur in the adjuvant treatment of cancer and we feel that further efforts should proceed to identify the appropriate dose for such a trial.