Efficacy of a Mouthwash Containing CHX and CPC in SARS-CoV-2-Positive Patients: A Randomized Controlled Clinical Trial.

Soon after the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, preprocedural mouthwashes were recommended for temporarily reducing intraoral viral load and infectivity of individuals potentially infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in order to protect medical personnel. Particularly, the antiseptic cetylpyridinium chloride (CPC) has shown virucidal effects against SARS-CoV-2 in vitro. Therefore, the aim of this randomized controlled clinical trial was to investigate the efficacy of a commercially available mouthwash containing CPC and chlorhexidine digluconate (CHX) at 0.05% each in SARS-CoV-2-positive patients as compared to a placebo mouthwash. Sixty-one patients who tested positive for SARS-CoV-2 with onset of symptoms within the last 72 h were included in this study. Oropharyngeal specimens were taken at baseline, whereupon patients had to gargle mouth and throat with 20 mL test or placebo (0.9% NaCl) mouthwash for 60 s. After 30 min, further oropharyngeal specimens were collected. Viral load was analyzed by quantitative reverse transcriptase polymerase chain reaction, and infectivity of oropharyngeal specimens was analyzed by virus rescue in cell culture and quantified via determination of tissue culture infectious doses 50% (TCID50). Data were analyzed nonparametrically (α = 0.05). Viral load slightly but significantly decreased upon gargling in the test group (P = 0.0435) but not in the placebo group. Viral infectivity as measured by TCID50 also significantly decreased in the test group (P = 0.0313), whereas there was no significant effect but a trend in the placebo group. Furthermore, it was found that the specimens from patients with a vaccine booster exhibited significantly lower infectivity at baseline as compared to those without vaccine booster (P = 0.0231). This study indicates that a preprocedural mouthwash containing CPC and CHX could slightly but significantly reduce the viral load and infectivity in SARS-CoV-2-positive patients. Further studies are needed to corroborate these results and investigate whether the observed reductions in viral load and infectivity could translate into clinically useful effects in reducing COVID-19 transmission (German Clinical Trials Register DRKS00027812).

[Quality indicators and structural requirements for Cardiac Arrest Centers-Update 2021]. / Qualitätskriterien und strukturelle Voraussetzungen für Cardiac Arrest Zentren ­ Update 2021: Deutscher Rat für Wiederbelebung/German Resuscitation Council (GRC).

An update of the first description of quality indicators and structural requirements for Cardiac Arrest Centers from 2017 based on first experiences and certifications is presented. Criteria were adjusted, substantiated and in some parts redefined for feasibility in everyday clinical use.

Retrospective study of anaplasmosis in countries of North Africa and the Middle East.

Anaplasmosis is a tick-borne disease caused by bacteria of the genus Anaplasma, which consists of six species affecting livestock and wild animals, and humans, worldwide. Anaplasma marginale and Anaplasma phagocytophilum are the most important species for veterinary and human health. Infections of livestock have a noticeable economic impact due to reduced growth or loss of animals. This study provides information on anaplasmosis in animal populations of countries in North Africa and the Middle East. Relevant national and international scientific publications were evaluated for studies of the epidemiology of anaplasmosis between 1959 and 2019. The serological assay results showed a prevalence of 13.5%-89.7% in cattle in North Africa, and 35%-36% in cattle, 44.7%-94% in small ruminants and 10.83% in camels in Middle Eastern countries. Sample positivity for Anaplasma species by molecular assays revealed a range of 3.5%-69.3% in cattle, 2.5%-95% in small ruminants and 17.7%-88.89% in camels in North African countries and 95% of cattle, 15.5%-66.7% of small ruminants and 28%-95.5% of camels in the Middle East. Polymerase chain reaction (PCR) detection of all six Anaplasma species in North Africa and of Anaplasma ovis and A. phagocytophilum in the Middle East was reported in livestock. This review shows that anaplasmosis is endemic in North Africa and the Middle East and represents a threat not only to the economies of these countries but also to public health. Thus, surveillance and implementation of control measures are important tools to optimise future strategic control programmes and prevent spread to neighbouring countries.

L'anaplasmose est une maladie transmise par les tiques et causée par une bactérie du genre Anaplasma, qui recouvre six espèces affectant le bétail et la faune sauvage ainsi que les humains dans le monde entier. Anaplasma marginale et Anaplasma phagocytophilum sont les espèces les plus importantes en médecine vétérinaire et humaine. Chez le bétail cette maladie a des répercussions économiques significatives en raison du ralentissement de la croissance ou des pertes d'animaux qu'elle induit. Les auteurs présentent les informations qu'ils ont réunies sur l'anaplasmose dans les populations animales de plusieurs pays d'Afrique du Nord et du Moyen-Orient. Les données analysées proviennent des publications scientifiques internationales et nationales consacrées à l'épidémiologie de l'anaplasmose entre 1959 et 2019. Le taux de prévalence tel qu'il ressort des enquêtes sérologiques consultées fluctuait chez les bovins d'Afrique du Nord de 13,5 % à 89,7 %, tandis que dans les pays du Moyen-Orient, la prévalence était de 35 %-36 % chez les bovins, variait de 44,7 % à 94 % chez les petits ruminants et s'élevait à 10,83 % chez les camélidés. Le pourcentage d'échantillons positifs pour Anaplasma spp. parmi ceux soumis à des tests moléculaires dans les pays d'Afrique du Nord variait de 3,5 % à 69,3 % chez les bovins, de 2,5 % à 95 % chez les petits ruminants et de 17,7 % à 88,89 % chez les camélidés, tandis qu'au Moyen-Orient il était de 95 % chez les bovins et variait de 15,5 % à 66,7 % chez les petits ruminants et de 28 % à 95,5 % chez les camélidés. Chez les animaux d'élevage, en recourant à l'amplification en chaîne par polymérase (PCR), les six espèces d'Anaplasma ont été détectées en Afrique du Nord tandis qu'au Moyen-Orient seules Anaplasma ovis et A. phagocytophilum ont été détectées. Cette revue de la littérature montre que l'anaplasmose est présente à l'état endémique en Afrique du Nord et au Moyen-Orient et qu'elle représente une menace non seulement pour les économies de ces pays mais aussi pour la santé publique. Les auteurs en concluent que la surveillance et la mise en place de mesures de contrôle constituent des outils essentiels pour optimiser les futurs programmes stratégiques de lutte contre la maladie et prévenir sa propagation vers les pays voisins.

La anaplasmosis es una enfermedad transmitida por garrapatas cuyo agente etiológico son las bacterias del género Anaplasma, formado por seis especies que afectan al ganado y los animales silvestres, así como al ser humano, en todo el mundo. Anaplasma marginale y Anaplasma phagocytophilum son las especies más importantes desde el punto de vista de la veterinaria y la medicina. Las infecciones del ganado tienen notorios efectos económicos porque lastran el crecimiento de los animales o causan la pérdida de ejemplares. Los autores describen un estudio que aporta información sobre la anaplasmosis en las poblaciones animales de países norteafricanos y de Oriente Medio. Para llevar a cabo el estudio se examinaron publicaciones científicas nacionales e internacionales en busca de investigaciones que arrojaran luz sobre la epidemiología de la anaplasmosis entre 1959 y 2019. Los resultados de los ensayos serológicos descritos en la bibliografía revelaban una prevalencia del 13,5% al 89,7% en el ganado bovino norteafricano y, en cuanto a los países de Oriente Medio, del 35% al 36% en bovinos, del 44,7% al 94% en pequeños rumiantes y del 10,83% en camellos. El análisis de las muestras con técnicas moleculares deparaba los siguientes porcentajes de positividad para especies de Anaplasma: en los países norteafricanos, un intervalo del 3,5% al 69,3% en bovinos, del 2,5% al 95% en pequeños rumiantes y del 17,7% al 88,89% en camellos; en Oriente Medio, un 95% en bovinos, del 15,5% al 66,7% en pequeños rumiantes y del 28% al 95,5% en camellos. En el ganado bovino se describía la detección por reacción en cadena de la polimerasa (PCR) de las seis especies de Anaplasma en África del Norte y de Anaplasma ovis y A. phagocytophilum en Oriente Medio. Este estudio pone de manifiesto que la anaplasmosis es endémica en África del Norte y Oriente Medio y representa una amenaza no solo para la economía de estos países, sino también para la salud pública. La vigilancia y la aplicación de medidas de control son por lo tanto herramientas importantes para optimizar futuros programas estratégicos de lucha y prevenir la extensión de la enfermedad a países vecinos.

[Why do we need cardiac arrest centers?] / Warum brauchen wir Cardiac-Arrest-Zentren?

In patients with out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) following cardiopulmonary resuscitation (CPR), the prognosis is influenced by various factors. In the prehospital setting, the duration of ischemia from the time of onset of cardiac arrest to the beginning of effective resuscitation measures is by far the most critical and determining factor for outcome. This interval can be shortened by an increase in the rate of lay CPR measures. With respect to intrahospital follow-up care, a number of structural factors have a relevant influence on prognosis. According to the literature, case volume, size of the hospital and the number of post-OHCA patients treated per year also have a large influence on the further prognosis. The crucial factor here is the availability and permanent readiness of a catheterization laboratory with the possibility of an immediate coronary intervention. In OHCA patients with ST-segment elevation myocardial infarction (STEMI), the time passed until the reopening of the occluded infarcted vessel is of paramount importance for survival. The 24/7 around the clock availability of a catheterization laboratory is therefore one of the indispensable prerequisites for a cardiac arrest center (CAC). In addition, a number of technical, structural, and organizational arrangements must be implemented in the CAC clinics in order to fulfil the requirements for such a center. The certification of CACs is currently being implemented by the German Resuscitation Council (GRC) and the German Society of Cardiology (DGK). As an important aim the GRC and the medical societies involved are hoping to avoid misallocation of post-OHCA patients to the nearest hospital, which may not be a suitable center for the treatment of these patients. Future studies will show whether CACs can indeed comprehensively improve the prognosis of OHCA patients following successful prehospital resuscitation.

Polymer-infiltrated ceramic CAD/CAM inlays and partial coverage restorations: 3-year results of a prospective clinical study over 5 years.

OBJECTIVE: The aim of this prospective clinical 5-year study was to evaluate the long-term behavior of monolithic computer-aided design and computer-aided manufacturing (CAD/CAM)-fabricated minimally invasive polymer-infiltrated ceramic network (PICN) inlays and partial coverage restorations (PCR). MATERIAL AND METHODS: Posterior teeth of 47 patients were restored with 103 restorations (45 inlays, 58 PCRs). After defect-oriented preparations, monolithic PICN restorations of VITA Enamic were fabricated with a CAD/CAM system (inEoS blue/CEREC inLab MCXL) and adhesively bonded (Variolink II). Clinical reevaluations were so far performed at baseline and 6, 12, 24, and 36 months after insertion according to modified United States Public Health Service (USPHS) criteria. Absolute failures were demonstrated by Kaplan-Meier survival rate and relative failures by Kaplan-Meier success rate. A logistic regression model was adjusted for modified USPHS criteria to investigate time and restoration effects (p < 0.05). RESULTS: After an observation time of 3 years, survival rates were 97.4% for inlays and 95.6% for PCRs. Three restorations had to be replaced due to clinically unacceptable fractures. Secondary caries and debonding were not observed. The 3-year Kaplan-Meier success rate was 84.8% for inlays and 82.4% for PCRs. The decrease in marginal adaption (p = 0.0005), increase in marginal discoloration (p < 0.0001), and surface roughness (p = 0.0005) over time were significant. Color match and anatomic form were excellent. No significant differences were found between both types of restorations for survival (p = 0.716) and success rate (p = 0.431). CONCLUSIONS: Minimally invasive PICN restorations showed a favorable clinical performance over an observation period of 36 months. However, clinical long-term data have to be awaited. CLINICAL RELEVANCE: PICN restorations are a suitable treatment option for posterior inlays and PCRs.

[Does FVIII-activity increase with age in patients with haemophilia A and carriers of haemophilia A?]. / Hämophilie-A-Patienten und Konduktorinnen für Hämophilie A. Steigt die FVIII-Aktivität mit dem Lebensalter?

UNLABELLED: The retrospective cohort study surveys the influence of age, co-morbidity and laboratory values on FVIII-activity (FVIII:C) in patients with haemophilia A with (mild n = 48, moderate n = 10, severe n = 7 and carriers n = 23). Median observation was 19 years for patients with haemophilia A and 9,5 years for carriers. RESULTS: FVIII:C levels collected from patients with mild haemophilia A displayed a significant median increase of 6.5% with proceeding age (p = 0.0013). Patients with moderate haemophilia A (and carriers of haemophilia A) showed a non significant median increase of 1.05% (carriers 8%). Eight patients showed FVIII:C levels at last blood withdrawal that indicated a change of severity from moderate to mild haemophilia A. A significant correlation was found between FVIII:C and VWF:RCo (p = 0.0203) and AFP (p < 0.0005). The correlation between FVIII:C and triglycerides and LDH was significant negative (p < 0.0005). No significant correlation could be found for FVIII:C and co-morbidity, fibrinogen, cholesterol and VWF:Ag.

Patients with isolated prolonged in vitro bleeding time. Clinical symptoms.

UNLABELLED: In patients with isolated prolonged in vitro bleeding time there is no standardised treatment concept. With this study we characterized the extent of bleeding symptoms. PATIENTS, METHODS: All diagnoses known to cause prolonged in vitro bleeding time (PFA-100) (epinephrine-cartridge >160 s, ADP-cartridge > 120 s) have been excluded, such as platelet function disorders, effects of medications, nutrition or von Willebrand disease. 75 patients (77%, n = 58 women; 23%, n = 17 men, median age 46 (16-81) years were included. All bleeding symptoms have been stored in a databank with help of a comprehensive questionnaire. RESULTS: 78% (n = 54) of all patients reported of having had an operation, 69.8% (n = 37) of them described postoperative bleedings (p = 0.0373). 13.5% (n = 5) of the 54 could remember having been randomly treated by the administration of a transfusion and only 2.7% (n = 1) were treated by substitution of von Willebrand factor. 71% (n = 51) patients indicated haematoma (p = 0.8116). About 33.8% (n = 24) patients had gum bleeding and 40.8% (n = 29, p = 0.7808) patients reported bleeding after the dentist. 41.4% (n = 29) patients suffered under frequent epistaxis (p = 0.0212). There was no correlation between prolonged epinephrine bleeding time to VWF:Ag (rho = 0.16) nor to VWF:RCo (rho = 0.12) nor between prolonged epinephrine and ADP bleeding time (rho = 0.01) nor to ROTEM® analysis. CONCLUSION: Patients with isolated prolonged PFA are mainly women and can be affected by all kinds of bleedings while haematoma is the main symptom. VWD might not be causal.

[Immunsuppressive therapy in virus-negative eosinophilic inflammatory cardiomyopathy]. / Immunsuppressive Therapie bei Virus-negativer eosinophiler inflammatorischer Kardiomyopathie.

HISTORY AND ADMISSION FINDINGS: A 52 year-old women presented with long-standing dyspnoea at exercise as a symptom of heart failure. A coronary heart disease had been excluded by coronary angiography a year before. The symptoms had persisted despite application of guideline-based anticongestive medication. INVESTIGATIONS: Electrocardiography showed sinus rhythm with decreased anterior wall amplitudes without acute ischemic signs. The white blood count revealed elevated leucocytes with high numbers of eosinophilic granulocytes. Echocardiography demonstrated severe left ventricular dysfunction with an ejection fraction of 30 % and a left ventricular end-diastolic diameter of 75 mm. Magnetic resonance imaging showed a pathologic late enhancement in the left ventricular wall. Six myocardial biopsies were obtained and revealed virus-negative eosinophilic inflammatory cardiomyopathy with focal fibrotic scarring. DIAGNOSIS, TREATMENT AND COURSE: The patient was treated according to a previously published study on virus-negative inflammatory heart disease with prednisone 1 mg/kg daily for 4 weeks followed by 0.33 mg/kg daily for 5 month and azathioprine 2 mg/kg daily for 6 month. The echocardiography of the left ventricular function showed an increase from 30 to 45 % and the clinical symptoms of the heart failure resolved to NYHA II. CONCLUSION: In patients with virus-negative eosinophilic inflammatory cardiomyopathy standardized therapy with prednisone and azathioprine can improve LV function and clinical symptoms.

Measuring the effect of a study meal on portal concentrations of glucagon-like peptide 1 (GLP-1) in non diabetic and diabetic patients with liver cirrhosis: transjugular intrahepatic portosystemic stent shunt (TIPSS) as a new method for metabolic measurements.

BACKGROUND: Diabetes in liver cirrhosis is associated with a blunted insulin response, which might be explained by an impaired release of the incretin hormone glucagon-like peptide 1 (GLP-1) into the portal circulation. AIMS: To investigate basal and stimulated portal venous and peripheral GLP-1 concentrations in non-diabetic (ND) and diabetic (D) patients with liver cirrhosis undergoing transjugular intrahepatic portosystemic stent shunt (TIPSS) implantation. PATIENTS AND METHODS: After elective TIPSS portalvenous and peripheral probes were drawn from 10 ND and 10 D patients with stable liver disease during an oral metabolic test and plasma glucose, immunoreactive GLP-1, insulin and C-peptide were measured. RESULTS: The study meal led to a significant rise in portal GLP-1 levels in ND and D. Basal and stimulated portal GLP-1 concentrations were not significantly different between ND and D. Peripheral GLP-1 did not differ significantly from portal venous levels. Insulin response in ND was more pronounced in the portal blood than in the periphery and was absent in D. CONCLUSION: TIPSS allows a direct evaluation of hormonal changes in the portal circulation during an oral metabolic tolerance test. A disturbed GLP-1 secretion does not play a role in blunting the insulin response observed in patients with hepatogenous diabetes.

[Olfactory dysfunction in Parkinson's disease: its role as a new cardinal sign in early and differential diagnosis]. / Riechstörungen bei Morbus Parkinson : Ein neues Kardinalsymptom mit Relevanz für die Früh- und Differenzialdiagnose?

Olfactory dysfunction is a prominent symptom in Parkinson's disease (PD) and found in about 70-100% of patients. In earlier studies significant loss of olfactory function seemed to be unrelated to disease duration, did not correlate with motor function, and was uninfluenced by antiparkinsonian medication. We suggest that the increase of dopaminergic cells in the olfactory bulb is responsible for the hyposmia in PD patients. Interestingly, this olfactory dysfunction is not found in progressive supranuclear palsy or corticobasal degeneration. In multiple system atrophy, the deficit is mild and indistinguishable from cerebellar syndromes of other aetiologies. Intact olfaction has also been reported recently in Parkin disease (PARK 2) and vascular parkinsonism. Olfactory tests may significantly enhance the diagnostic armamentarium in the differential diagnosis of parkinsonian syndromes and indeterminate tremors. Furthermore, olfactory testing may also prove to be a useful aid in the early or "preclinical" detection of PD, once effective disease-modifying therapies are found. Braak and coworkers have confirmed the widespread, extranigral pathology in PD and suggested that pathology in the anterior olfactory region may be one of the earliest appearances of neurodegeneration in PD.

[Treatment of the acute coronary syndrome in Germany: experiences in a German cluster of the GRACE registry]. / Behandlung des akuten Koronarsyndroms in Deutschland: Erfahrungen eines deutschen Clusters des GRACE-Registers.

BACKGROUND: The acute coronary syndrome (ACS) remains a major cause of mortality and morbidity in the western world. The Global Registry of Acute Coronary Events (GRACE) documents inpatients with all types of ACS and a follow-up at three months in Germany and worldwide. METHODS: The data of the German Cluster Detmold were compared with data from the worldwide GRACE registry (31,070 patients). Data from 849 patients with ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA) were collected from October 2001 to September 2005 in eight participating hospitals in the GRACE2 Cluster Detmold. RESULTS: Compared with the worldwide GRACE data the patients in the Cluster Detmold had longer pre-hospital admission times (STEMI patients < 1 h: 13.9 % vs. 17.0 %; p < 0.05); more frequent interventions (PCI 60.1 % vs. 48.7%; p < 0.001) and less thrombolysis (17.9 vs. 42.5%; p < 0.001) in STEMI patients; more frequent use of platelet inhibitors (clopidogrel and ticlopidine, 93.4 % vs. 89.4%; p < 0.001) and unfractionated heparin (69.8 % vs. 36.5; p < 0.001), and less frequent use of low molecular weight heparin (31.1 % vs. 51.2%; p < 0.001); more frequent use of RAS blocking agents (80.2 vs. 66.6, p < 0.001) and beta blockers (87.4 vs. 78.8, p < 0.001) and less frequent use of lipid lowering agents (23.5 vs. 72.5%; p < 0.001). CONCLUSIONS: Current management of ACS in Germany closely follows the recommendations of the German society of Cardiology. Differences in practice may account for the observed substantially lower event rates in Germany during hospitalization, but there is still room for improvement in the pre-hospital phase und in the degree to which pharmacotherapy is used for secondary prevention.

A case of cerebral Whipple's disease initially presenting with isolated focal myoclonus.

Neurological manifestations in Whipple's disease are highly variable and tend to occur at later stages of the disease. However, isolated, focal neurological symptoms are reported to be rare. Here we describe the successful treatment of a case of cerebral Whipple's disease initially presenting solely with isolated myoclonic jerks of the left hand and forearm evolving to a segmental myoclonus at a later stage. Additionally, we present - to our knowledge - a novel treatment by administration of immunomodulatory therapy (IVIg) in addition to established antibiotics.