[Endogenous Candida endophthalmitis: diagnostics and treatment options based on case studies]. / Endogene Candida-Endophthalmitis: Diagnostik und Therapieoptionen anhand von Fallbeispielen.

BACKGROUND: Endogenous Candida endophthalmitis is an emergency that can threaten vision and the eye as a whole organ but also the life of the patient due to its systemic cause. MATERIAL AND METHOD: Retrospective case evaluation of the University Hospital for Ophthalmology Halle (Saale) and the Eye Clinic of the Ernst von Bergmann Hospital Potsdam from 2017-2022. (Age, gender, side involvement, underlying diseases, symptoms, preoperative and postoperative visual acuity, diagnostics, treatment and complications). The standardized procedures for endogenous Candida endophthalmitis are explained, the data are compared with the literature and treatment suggestions are presented. RESULTS: 8 patients with 14 eyes were treated for endogenous Candida endophthalmitis. Of the patients 2 were women and 6 were men. The overall average age was 70.25 years (53-82 years), 6 patients had bilateral eye involvement and 2 patients were affected on one side. All patients had several serious immunocompromising underlying diseases that were the cause of the candidemia. All patients underwent a pars plana vitrectomy (ppV) on the affected eyes except for one male patient who did not obtain permission for anesthesia. In addition to systemic treatment with antimycotics, voriconazole was routinely administered intravitreally during ppV. The patients received further intravitreal doses of voriconazole based on the findings. Vitreous body samples were taken from all patients during the ppV and detection of Candida albicans was possible in all cases. As part of the local perioperative treatment 1 patient received parabulbar administration of a triamcinolone depot in both eyes, 7 patients received a dexamethasone depot in 11 eyes and all 8 patients received findings-oriented local treatment with prednisolone acetate eye drops. visual acuity increased from preoperatively 1.2 logMar to 1.0 logMar. Postoperative retinal detachment did not occur and there were no serious perioperative complications. 2 patients died from one of the underlying diseases after 3 and 25 months, respectively. CONCLUSION: Despite an increasing number of case series, there are still no uniform guidelines for ophthalmologists in Germany. There is agreement regarding systemic treatment and the intravitreal administration of antifungal agents. The role of ppV has not yet been clearly defined and the question of the adjuvant use of steroids (systemic and/or local) has also not been conclusively clarified.

[Endogenous Candida endophthalmitis]. / Endogene Candida-Endophthalmitis.

Endogenous Candida endophthalmitis is a rare but vision-threatening disease. In most cases, endogenous endophthalmitis caused by Candida species has a better prognosis than endogenous endophthalmitis caused by other fungal species or bacteria but the prognosis still depends heavily on the time required for diagnosis and subsequent treatment as well as the initial visual acuity. Suggestions for treatment algorithms have already been made in the past but binding guidelines in ophthalmology only exist sporadically due to the rarity of the disease. This review discusses the current knowledge on endogenous Candida endophthalmitis and draws conclusions from the current study situation.

[High myopia in vitrectomized eyes : Contraindication for minimally invasive glaucoma surgery implant?] / Hohe Myopie bei vitrektomiertem Auge : Kontraindikation für minimal-invasive glaukomchirurgische Implantate?

Minimally invasive glaucoma surgery (MIGS) implants, such as XEN® gel stent are additional procedures in glaucoma treatment, which were designed to reduce the postoperative risk of severe hypotony and further complications. Until now the contraindications for every implant have not yet been identified. This case report describes the disastrous follow-up after implantation of a XEN® gel stent in the only high myopic eye of a patient. Despite elaborate subsequent interventions massive choroidal hemorrhage occurred with loss of the remaining visual field and total loss of visual acuity. The ocular pressure could be stabilized only after explantation of the XEN® gel stent. Patients with high myopia and the associated thin sclera, vitrectomized eyes and previous treatment with mitomycin C should be selected very carefully for XEN® gel stent. If these criteria are present the XEN® gel stent should be avoided whenever possible.

[Ocular injuries from fireworks in the past 11 years : Evaluation of the University Hospital and Polyclinic for Ophthalmology Halle]. / Feuerwerksverletzungen am Auge in den letzten 11 Jahren : Eine Auswertung der Universitätsklinik und Poliklinik für Augenheilkunde Halle.

PURPOSE: Every year around New Year's Eve severe eye injuries are caused by fireworks. There is a large variety ranging from slight superficial injuries to very severe trauma necessitating extensive and sometimes repeated surgical treatment. As a consequence the patients not only suffer from functional or cosmetic impairments but also from socioeconomic problems, such as reduced capacity to work and inability to work. All firework-related eye injuries treated at the University Hospital Halle from 2008 to 2018 were retrospectively and systematically analyzed. MATERIAL AND METHODS: The patients were analyzed with respect to age, gender, injury distribution, type of injury, circumstances, form of treatment, consequences and duration of inability to work. RESULTS: From the turn of the year 2008/2009 to the turn of the year 2018/2019 a total of 144 eyes from 116 patients were treated at the ophthalmology department of the University Hospital Halle. The injuries involved 80 male patients (69%) and 36 female patients (31%), among them 44 children (38%) aged under 18 years, 81 right and 63 left eyes. In 28 patients both eyes were affected. Of the patients 44% handled the fireworks themselves and 56% were bystanders. Injuries were mostly caused by bangers (37%) and rockets (24%). Of the patients 37 had to be hospitalized, 14 eyes needed immediate surgical treatment, 2 eyes needed surgery later on in irritation-free intervals and 12 eyes needed repeated surgery. The duration of inability to work was on average 21.6 days, 2 eyes went blind because of the fireworks-related injury and 29% of the patients had visual impairments of which 43% were classified as severe impairments. CONCLUSION: Fireworks-related injuries are preventable injuries. As in most cases children, young adults and bystanders are affected by fireworks injuries, prophylactic and educational programs are urgently needed and legal regulations are necessary.

[When the "lantern goes out"-maximum surgery pays off in the case of severe eye trauma]. / Wenn die "Laterne ausgeht" ­ Maximalchirurgie lohnt sich bei schwerstem Augentrauma.

Trauma surgeons are often confronted with severe complex eyeball injuries. The primary wound treatment and internal reconstruction are carried out depending on the surgical experience. The following case report describes a patient with severe eyeball rupture, from the preoperative findings up to the current status 1 year after the injury. After the initial severe trauma and complex primary reconstruction with subsequent pole to pole surgery in the irritation-free interval, a good functional and cosmetic result was achieved. Even after severe eyeball injuries the best possible primary reconstruction should be strived for. Secondary corrections are possible in irritation-free periods and can help the patient to achieve functional and cosmetic rehabilitation.

Epidural needle insertion : A large registry analysis.

BACKGROUND: Dural puncture, paraesthesia and vascular puncture are the most common complications of epidural catheter insertion. Their association with variation in midline needle insertion depth is unknown. OBJECTIVE: This study evaluated the risk of dural and vascular punctures and the unwanted events paraesthesia and multiple skin punctures related to midline needle insertion depth. MATERIAL AND METHODS: A total of 14,503 epidural catheter insertions including lumbar (L1-L5; n = 5367), low thoracic (T7-T12, n = 8234) and upper thoracic (T1-T6, n = 902) insertions, were extracted from the German Network for Regional Anaesthesia registry between 2007 and 2015. The primary outcomes were compared with logistic regression and adjusted (adj) for confounders to determine the risk of complications/events. Results are presented as odds ratios (OR, [95% confidence interval]). MAIN RESULTS: Midline insertion depth depended on body mass index, sex, and spinal level. After adjusting for confounders increased puncture depth (cm) remained an independent risk factor for vascular puncture (adjOR 1.27 [1.09-1.47], p = 0.002) and multiple skin punctures (adjOR 1.25 [1.21-1.29], p < 0.001). In contrast, dural punctures occurred at significantly shallower depths (adjOR 0.73 [0.60-0.89], p = 0.002). Paraesthesia was unrelated to insertion depth. Body mass index and sex had no influence on paraesthesia, dural and vascular punctures. Thoracic epidural insertion was associated with a lower risk of vascular puncture than at lumbar sites (adjOR 0.39 [0.18-0.84], p = 0.02). CONCLUSION: Variation in midline insertion depth is an independent risk factor for epidural complications; however, variability precludes use of depth as a reliable guide to insertion in individual patients.

Improving the forecast for biodiversity under climate change.

New biological models are incorporating the realistic processes underlying biological responses to climate change and other human-caused disturbances. However, these more realistic models require detailed information, which is lacking for most species on Earth. Current monitoring efforts mainly document changes in biodiversity, rather than collecting the mechanistic data needed to predict future changes. We describe and prioritize the biological information needed to inform more realistic projections of species' responses to climate change. We also highlight how trait-based approaches and adaptive modeling can leverage sparse data to make broader predictions. We outline a global effort to collect the data necessary to better understand, anticipate, and reduce the damaging effects of climate change on biodiversity.

A randomized trial on chlorhexidine dressings for the prevention of catheter-related bloodstream infections in neutropenic patients.

BACKGROUND: Central venous catheter (CVC)-related bloodstream infections (CRBSI) are a frequent cause of morbidity and mortality in patients with chemotherapy-induced neutropenia. Chlorhexidine containing catheter securement dressings may prevent CRBSI. PATIENTS AND METHODS: A multicenter randomized, controlled trial was conducted at 10 German hematology departments. We compared chlorhexidine-containing dressings with non-chlorhexidine control dressings in neutropenic patients. The primary end point was the incidence of definite CRBSI within the first 14 days (dCRBSI14) of CVC placement. Secondary end points included combined incidence of definite or probable CRBSI within 14 days (dpCRBSI14), overall (dpCRBSI), incidence of unscheduled dressing changes and adverse events. RESULTS: From February 2012 to September 2014, 613 assessable patients were included in the study. The incidence of dCRBSI14 was 2.6% (8/307) in the chlorhexidine and 3.9% (12/306) in the control group (P = 0.375). Both dpCRBSI14 and dpCRBSI were significantly less frequent in the study group with dpCRBSI14 in 6.5% (20/307) of the chlorhexidine group when compared with 11% (34/306) in the control group (P = 0.047), and dpCRBSI in 10.4% (32/307) versus 17% (52/306), respectively (P = 0.019). The frequency of dressing intolerance with cutaneous and soft tissue abnormalities at the contact area was similar in both groups (12.4% and 11.8%; P = 0.901). CONCLUSIONS: Although the trial failed its primary end point, the application of chlorhexidine containing catheter securement dressings reduces the incidence of definite or probable CRBSI in neutropenic patients. CLINICAL TRIALS NUMBER: NCT01544686 (Clinicaltrials.gov).

Density functional theory based screening of ternary alkali-transition metal borohydrides: a computational material design project.

We present a computational screening study of ternary metal borohydrides for reversible hydrogen storage based on density functional theory. We investigate the stability and decomposition of alloys containing 1 alkali metal atom, Li, Na, or K (M(1)); and 1 alkali, alkaline earth or 3d/4d transition metal atom (M(2)) plus two to five (BH(4))(-) groups, i.e., M(1)M(2)(BH(4))(2-5), using a number of model structures with trigonal, tetrahedral, octahedral, and free coordination of the metal borohydride complexes. Of the over 700 investigated structures, about 20 were predicted to form potentially stable alloys with promising decomposition energies. The M(1)(Al/Mn/Fe)(BH(4))(4), (Li/Na)Zn(BH(4))(3), and (Na/K)(Ni/Co)(BH(4))(3) alloys are found to be the most promising, followed by selected M(1)(Nb/Rh)(BH(4))(4) alloys.

Patient satisfaction with anaesthesia care: development of a psychometric questionnaire and benchmarking among six hospitals in Switzerland and Austria.

BACKGROUND: We describe the development and comparison of a psychometric questionnaire on patient satisfaction with anaesthesia care among six hospitals. METHODS: We used a rigorous protocol: generation of items, construction of the pilot questionnaire, pilot study, statistical analysis (construct validity, factor analysis, reliability analysis), compilation of the final questionnaire, main study, repeated analysis of construct validity and reliability. We compared the mean total problem score and the scores for the dimensions: 'Information/Involvement in decision-making', and 'Continuity of personal care by anaesthetist'. The influence of potential confounding variables was tested (multiple linear regression). RESULTS: The average problem score from all hospitals was 18.6%. Most problems are mentioned in the dimensions 'Information/Involvement in decision-making' (mean problem score: 30.9%) and 'Continuity of personal care by anaesthetist' (mean problem score: 32.2%). The overall assessment of the quality of anaesthesia care was good to excellent in 98.7% of cases. The most important dimension was 'Information/Involvement in decision-making'. The mean total problem score was significantly lower for two hospitals than the total mean for all hospitals (significantly higher at two hospitals) (P<0.05). Amongst the confounding variables considered, age, sex, subjective state of health, type of anaesthesia and level of education had an influence on the total problem score and the two dimensions mentioned. There were only marginal differences with and without the influence of the confounding variables for the different hospitals. CONCLUSIONS: A psychometric questionnaire on patient satisfaction with anaesthesia care must cover areas such as patient information, involvement in decision-making, and contact with the anaesthetist. The assessment using summed scores for dimensions is more informative than a global summed rating. There were significant differences between hospitals. Moreover, the high problem scores indicate a great potential for improvement at all hospitals.