Centrallasarettet Växjö

HighlightsWhat are the main findings?Smartphone-based eye scanning can detect opioid use without individualization up to 5 h after intake.For smartphone-based eye scanning, there is no need for special lighting equipment.What is the implication of the main finding?Consumer electronics is sufficiently good for high-quality pupillometry.Smartphone-based eye scanning can be the future for detecting opioid consumption.Opioids are known to constrict pupils, and mobile phone-based self-administered eye scanning (MPSES) offers a potential method for monitoring opioid use in real-world settings. A clinical trial with 12 volunteers measured pupil size using MPSES under different light conditions (approx. 50 or approx. 500 lux) in the lab and over a week at home. Each participant made approximately 21 home tests, 12 in the lab without oxycodone and 16 in the lab after oxycodone intake. At the second visit the participants received a single dose of 20 mg oxycodone, and their pupil size was monitored hourly for 5 h. The pupil size after oxycodone intake was compared to drug-naïve tests performed at the lab and at home. Logistic regression models were built using measured pupil size and light conditions measured by the phone during each test, and a dichotomous variable indicating tests before or after oxycodone dosing as the outcome. The model demonstrated high classification accuracy (AUC = 0.94), with 82% true positives, 9% false positives, 91% true negatives and 18% false negatives. Misclassifications were largely due to difficulties measuring pupil size in individuals with corneal arcus, causing most of the false positive findings, and other interindividual differences. This shows that MPSES, including monitoring of ambient light conditions, can effectively detect opioid use within the 50–500 lux range. Our study paves the way for using MPSES to detect opioid use.

AIM. Right ventricular (RV) function plays an important role in determining symptom burden and clinical outcomes in pulmonary hypertension (PH). Global Wasted Work (GWW) quantifies mechanical inefficiencies in RV performance associated with elevated a

We tested for airborne epimeletic (care-giving) behaviour in Common Swift Apus apus towards young swifts during their first flight. Tests were performed where colonies of Common Swift and Western House Martin Delichon urbicum co-occur. Three variants of a flying dummy were used; two with pointed wings of which one entirely black (1) and one with partly white body (2). The third was black with broad wings (3). Reactions were documented on film. Swifts and martins had opposite reactions to dummies 1 and 2. As we anticipated, martins seemed supportive in a test with dummy 2 and seemed to “guide” the dummy epimeletically. However, a swift approached dummy 2 in a support-like attempt, but deviated after a close look. In a test with dummy 3, swifts acted highly hostilely. We discuss reasons for these outcomes and the importance of dummy appearance. We illustrate the flight paths of the dummy, swifts and martins with trajectories, and the behaviour of the Western House Martin is shown in stepwise larger magnification stills of a video.

Introdução: A Peritonite Infecciosa Felina (PIF) é uma das doenças raras mais importantes que acomete felinos domésticos e selvagens, sendo uma mutação do coronavírus felino (CoVF). De modo geral, a doença pode manifestar-se como efusiva (úmida) ou não efusiva (seca) e apresentar quadros de inflamação granulomatosa no peritônio e vasculite imunomediada. Objetivo: Objetivou-se realizar uma revisão de literatura acerca da PIF e suas características. Metodologia: O presente resumo tem como base teórica as plataformas Google Acadêmico e SciELO, e descritores como "peritonite infecciosa felina", "coronavírus felino" e "doenças virais em felinos". Resultados: A PIF pode se caracterizar por uma infecção sistêmica e viral, tendo maior prevalência os gatos jovens e idosos, além dos portadores de enfermidades imunossupressoras como FIV e FeLV. A patogenia está associada a diversos mecanismos imunológicos desencadeados pelo vírus no organismo do animal, ocasionando uma doença autoimune. A principal fonte de infecção se dá mediante fezes de gatos infectados ou alimentos contaminados, através da via de transmissão oral-fecal. Ambas têm como sinais clínicos iniciais febre, anorexia, letargia, perda de peso, icterícia, diarreia, sinais neurológicos, oftálmicos e do trato respiratório superior. A forma não efusiva possui sinal clínico inespecífico, porém pode apresentar inflamação piogranulomatosa em vários órgãos, principalmente no sistema nervoso central, olhos, pulmões e órgãos da região abdominal. Já na efusiva (fase aguda da doença) há ascite, inflamação dos tecidos viscerais e serosite fibrinosa, devido ao extravasamento de líquido e proteínas causado pelas lesões nos vasos sanguíneos. O diagnóstico é post mortem, mediante histopatológico, entretanto o histórico clínico do animal e achados laboratoriais podem auxiliar. Pode ser feito a análise da efusão pela relação albumina-globulina, sendo <0,8 sugestivo para a PIF. Nos casos de PIF efusiva, faz-se o teste de Rivalta. A PIF não possui cura, portanto seu tratamento é de suporte, incluindo-se antibióticos, vitaminas, imunossupressores, interferon e drenagem do líquido. Conclusão: A PIF é uma doença de difícil diagnóstico e por isso o cuidado em locais de superpopulação deve ser redobrado. Assim, as medidas profiláticassão importantes a fim de evitar a disseminação da enfermidade e consequentemente infecções ou reinfecções pelo CoVF.

Tetanus (lockjaw) is a potentially life-threatening disease caused by a neurotoxin produced by the spore forming bacterium Clostridium tetani. The incidence has decreased substantially the last decades in most high-income countries, much due to well established vaccination programs. However, although uncommon, tetanus still remains a reality in Sweden. The condition is diagnosed based on clinical parameters and is hard to distinguish from many other more common differential diagnoses. Lack of vaccine induced antibodies is the most important risk factor for developing tetanus. Here we present a patient who developed tetanus two weeks following a puncture wound, but who was initially misdiagnosed with wake-up stroke. The case illustrates the importance of reviewing a patient's tetanus vaccine history, which determines what prophylactic measures are adequate to take, especially following potentially contaminated wounds.

Community acquired pneumonia (CAP) is associated with high in-hospital mortality. The initial correct diagnosis, risk assessment and initiation of treatment are responsibilities of the emergency department (ED). In Germany, emergency medicine is not well established nationwide and organized in a very heterogeneous manner. Therefore, systematic approaches to improve quality of care are scarce and standardisations of processes are required. Standardized care bundles for CAP identify patients at increased risk for an adverse outcome. Early detection of CAP in the emergency department is essential for initiating timely and appropriate treatment. As part of the nationwide CAP quality improvement program we use CRB-65 for initial risk stratification in the ED. In own investigations we demonstrated that implementation of systematic guideline based care bundles for pneumonia significantly improves quality of care in the ED subsequently leading to decreased mortality during hospitalization. Early standardized care bundles in the ED reduce length-of-stay in the hospital and the intensive care unit. Furthermore, those strategies are accompanied with an improvement of economic characteristics.

Background:This study aimed to determine human papillomavirus (HPV) status and to investigate p16INK4A and Ki-67 expression and their correlation with clinical parameters and survival in women with primary carcinoma of the vagina (PCV).Methods:The presence of HPV DNA was evaluated by PCR. Genotyping was performed by Luminex in 68 short-term (⩽2 years) and long-term (⩾8 years) PCV survivors. p16INK4A and Ki-67 expression was evaluated by immunohistochemistry.Results:Human papillomavirus DNA was detected in 43% of patients, the majority (63%) of whom were HPV16 positive. High p16INK4A expression was significantly correlated with low histopathological grade (P=0.004), HPV positivity (P=0.032), and long-term survival (P=0.045). High Ki-67 expression was negatively correlated with histopathological grade (P<0.001) and tumour size (P=0.047). There was an association between HPV positivity and low histopathological grade, but not between HPV positivity and survival.Conclusion:High p16INK4A expression was associated with long-term survival, but the only independent predictors for survival were tumour size and histopathological grade. Our results indicate that p16INK4A and Ki-67 expression might be useful in tumour grading, and that it might be possible to use p16INK4A expression as a marker for HPV positivity, but this has to be further elucidated.

Iatrogenic nerve injury caused by heat from dissection instruments is a significant problem in many areas of surgery. The aim of the present study was to compare the risk of nerve injury for three different dissection instruments: monopolar and bipolar electrosurgery (ES) and an ultrasonically activated (US) instrument. The biceps femoris muscle was cut in a standard manner just adjacent to the sciatic nerve using monopolar ES, bipolar ES or US shears. A total of 73 functional experiments were conducted in which the nerve was isolated, divided proximally, and stimulated supramaximally in 37 anaesthetized rats. The electromyographic (EMG) potential was recorded distally before and after each experiment. Nerve dysfunction was defined as more than 10 per cent loss of the evoked EMG potential. Fifty-nine nerves were examined histologically after dissection with the different instruments. The extent of heat damage was determined in four nerves that were divided with ES bipolar scissors and five that were divided with US shears. Reduction in the EMG potential was significantly more frequent in the monopolar ES group than in the US group. Morphological examination also showed significantly less nerve damage in the US group. US instruments may be safer than ES for dissection close to nerves.