Dangerous waters: outbreak of eye lesions caused by fresh water sponge spicules

Purpose To describe an extremely uncommon outbreak of eye lesions in a specific area of the Brazilian Amazonia. Methods Prospective noncomparative case series. Fifty-nine patients who developed eye lesions after swimming in the Araguaia river of Tocantins state in Brazil were examined. A team of ophthalmologists equipped with a slit-lamp, gonioscopic lenses, and indirect ophthalmoscopy performed full eye examination. Analysis of the flora and fauna of the river water was undertaken by a group of experts. Results and Conclusions Eighty-three eyes were affected. The most common lesions were corneal opacities seen in 34 eyes and conjunctival nodules diagnosed in 12 eyes. Severe visual acuity loss was detected in seven children with unilateral anterior chamber lesions. Spicules of the sponge species Drulia uruguayensis and Drulia ctenosclera were found inside three blind eyes that have been enucleated for diagnostic purposes. All eye lesions could be attributed to an outbreak of foreign bodies from fresh water sponges. Organic enrichment of the water resulting from the absence of sanitation probably was the key factor, which initiated a cycle of ecological imbalance that provoked human disease.

[When eating becomes dangerous...]

We report the case of a 59-year-old women with idiopathic insulin auto-immune syndrome, a rare cause of endogenous hyperinsulinemic hypoglycemia. It is characterized by extremely high levels of insulin in the presence of high titers of insulin antibodies despite the absence of previous insulin injections. Early postprandial increase in glucose concentrations due to impaired insulin action resulting from the buffering effect of the antibodies and late postprandial hypoglycemia as a consequence of the dissociation of insulin from the antibodies was observed. A correct diagnosis is important to avoid unnecessary investigations and surgery in these patients who are best treated conservatively - with a good prognosis - by fractionating carbohydrate intake during the day.

[Early genetic testing in nephrology - a diagnostic aid in ambiguous clinical situations]

Despite a growing number of identified genetic causes of monogenetic disorders, early molecular testing is rarely applied in daily nephrologic practice. In selected cases and to answer specific questions, molecular testing however can be helpful for the specialist. The future significance of genetic testing most likely lies in the area of individual risk profiling for polygenetic disorders. The basis for this testing however has yet to be established.

An empirical examination of the integration of causal attribution and social learning theories in achievement situations

Using path analysis, the present investigation sought to clarify possible operational linkages among constructs from social learning and attribution theories within the context of a self-esteem system. Subjects were 300 undergraduate university students who completed a measure of self-esteem and indicated expectancies for success and minimal goal levels for an experimental task. After completing the task and receiving feedback about their performance, subjects completed causal attribution and self-esteem questionnaires. Results revealed gender differences in the degree and strength of the proposed relations, but not in the mean levels of the variables studied. Results suggested that the integration of social learning and attribution theories within a single conceptual model provides a better understanding of students' behaviors and self-esteem in achievement situations.

The role of self-esteem in affective reactions to achievement-related situations

Investigated whether affective reactions in achievement settings were related to self-esteem in 308 undergraduates. Ss completed a self-esteem questionnaire and an affect questionnaire in which achievement outcomes and causal sources were manipulated within a short-story format. Affective reactions to various academic situations portrayed in the stories then were assessed and related to Ss' self-esteem. Resulting biserial correlations between the dichotomized affective reactions and self-esteem indicate that affective reactions to success and failure were related to Ss' level of self-esteem. An extrapolation from the present results and related research is that causal internalization with resulting self-referent affects may be facilitated by providing academic feedback consistent with self-esteem.

[Needle in the haystack - potentially dangerous syncope in childhood]

Syncope is a frequently observed symptom in pediatrics with teenagers being the age group most often affected. In contrast to older age, organic cardiac causes of syncope in child-hood are observed in a minority of only 2-5% of cases, in their majority pediatric syncopes thus are neurocardiogenic in origin. The rare organic cardiac causes that may manifest with syncope are all potentially dangerous entities such as cardiomyopathies, genetic primary electrical disease and some forms of structural heart disease, as well as some other rare diseases such as e.g. primary pulmonary hypertension. These diseases have to be actively looked for or excluded. Guidelines recommend patient evaluation including history, physical examination and ECG, which is sufficient to sort out suspect cases after a syncopal episode.

Fondaparinux - data on efficacy and safety in special situations

New anticoagulants promise to have better efficacy, more safety and/or a better manageability than traditional anticoagulants. However, knowledge is limited regarding special situations such as renal insufficiency, obesity, pregnancy, long-term therapy, heparin-induced thrombocytopenia, treatment in patients with mechanical heart valves, use for children, and in patients with a high risk of thromboembolic complications. These situations have rarely or even never been the objective of randomised controlled trials. The purpose of the present article is to summarize and discuss available data on efficacy and safety in these special situations for one of the first new anticoagulants, the indirect factor-Xa inhibitor fondaparinux. Furthermore, we discuss safety in licensed indications and management of bleeding complications and comment on measuring of drug concentration in plasma.

Hematometra presenting as an acute abdomen in a 13-year-old postmenarchal girl: a case report

Introduction Most underlying diseases for abdominal pain in children are not dangerous. However some require rapid diagnosis and treatment, such as acute ovarian torsion or appendicitis. Since reaching a diagnosis can be difficult, and delayed treatment of potentially dangerous diseases might have significant consequences, exploratory laparoscopy is a diagnostic and therapeutic option for patients who have unclear and potentially hazardous abdominal diseases. Here we describe a case where the anomaly could not be identified using a laparoscopy in an adolescent girl with acute abdomen. Case presentation A 13-year old postmenarchal caucasian female presented with an acute abdomen. Emergency sonography could not exclude ovarian torsion. Accurate diagnosis and treatment were achieved only after an initial laparoscopy followed by a laparotomy and after a magnetic resonance imaging scan a further laparotomy. The underlying disease was hematometra of the right uterine horn in a uterus didelphys in conjunction with an imperforate right cervix. Conclusion This report demonstrates that the usual approach for patients with acute abdominal pain may not be sufficient in emergency situations.

Must We Forgive?: Exploring the Limits and Possibilities of Forgiveness and Resentment

Conflict has marked civilization from Biblical times to the present day. Each of us, with our different and competing interests, and our desires to pursue those interests, have over time wronged another person. Not surprisingly then, forgiveness is a concern of individuals and groups¿communities, countries, religious groups, races¿yet it is a complex idea that philosophers, theologians, political scientists, and psychologists have grappled with. Some have argued that forgiveness is a therapeutic means for overcoming guilt, pain, and anger. Forgiveness is often portrayed as a coping mechanism¿how often we hear the phrase, ¿forgive and forget,¿ as an arrangement to help two parties surmount the complications of disagreement. But forgiveness is not simply a modus vivendi; the ability to forgive and conversely to ask for forgiveness, is counted as an admirable trait and virtue. This essay will explore the nature of forgiveness, which in Christian dogma is often posited as an unqualified virtue. The secular world has appropriated the Christian notion of forgiveness as such a virtue¿but are there instances wherein offering forgiveness is morally inappropriate or dangerous? I will consider the situations in which forgiveness, understood in this essay as the overcoming of resentment, may not be a virtue¿when perhaps maintaining resentment is as virtuous, if not more virtuous, than forgiving. I will explain the various ethical frameworks involved in understanding forgiveness as a virtue, and the relationship between them. I will argue that within Divine Command Theory forgiveness is a virtue¿and thus morally right¿because God commands it. This ethical system has established forgiveness as unconditional, an idea which has been adopted into popular culture. With virtue ethics in mind, which holds virtues to be those traits which benefit the person who possesses them, contributing to the good life, I will argue unqualified forgiveness is not always a virtue, as it will not always benefit the victim. Because there is no way to avoid wrongdoing, humans are confronted with the question of forgiveness with every indiscretion. Its limits, its possibilities, its relationship to one¿s character¿forgiveness is a concern of all people at some time if for no other reason than the plain fact that the past cannot be undone. I will be evaluating the idea of forgiveness as a virtue, in contrast to its counterpart, resentment. How can forgiveness be a response to evil, a way to renounce resentment, and a means of creating a positive self-narrative? And what happens when a sense of moral responsibility is impossible to reconcile with the Christian (and now, secularized imperative of) forgiveness? Is it ever not virtuous to forgive? In an attempt to answer that question I will argue that there are indeed times when forgiveness is not a virtue, specifically: when forgiveness compromises one¿s own self-respect; when it is not compatible with respect for the moral community; and when the offender is unapologetic. The kind of offense I have in mind is a dehumanizing one, one that intends to diminish another person¿s worth or humanity. These are moral injuries, to which I will argue resentment is a better response than forgiveness when the three qualifications cannot be met.

Thoraxschmerzen bei Kindern und Jugendlichen - das Herz?

Chest pain in children and adolescents is a frequent observation, although potentially relevant disease is rather rare and then found in situations with acute presentation. In children with an inflammatory/infectious clinical context the differential diagnosis is oesophagitis, pleuropneumonia or pericarditis. Potentially dangerous complications may be found in youth with predisposing conditions for aortic dissection, pneumothorax or pulmonary embolism, or even in rare instances for an acute coronary complication. In these cases aggressive diagnostic work-up is mandatory. In the frequent elective outpatient evaluation of teenagers with long-lasting episodes of chest pain, relevant underlying cardiovascular disease only rarely can be found as the cause. In the elective outpatient evaluation for chest pain, usually patient history and clinical examination may be enough to track the problem, the main role of the physician is to provide reassurance with minimal but appropriate testing.

Preparing Offspring for a Dangerous World: Potential Costs of Being Wrong

Adaptive maternal responses to stressful environments before young are born can follow two non-exclusive pathways: either the mother reduces current investment in favor of future investment, or influences offspring growth and development in order to fit offspring phenotype to the stressful environment. Inducing such developmental cues, however, may be risky if the environment changes meanwhile, resulting in maladapted offspring. Here we test the effects of a predator-induced maternal effect in a predator-free postnatal environment. We manipulated perceived predation-risk for breeding female great tits by exposing them to stuffed models of either a predatory bird or a non-predatory control. Offspring were raised either in an environment matching the maternal one by exchanging whole broods within a maternal treatment group, or in a mismatching environment by exchanging broods among the maternal treatments. Offspring growth depended on the matching of the two environments. While for offspring originating from control treated mothers environmental mismatch did not significantly change growth, offspring of mothers under increased perceived predation risk grew faster and larger in matching conditions. Offspring of predator treated mothers fledged about one day later when growing under mismatching conditions. This suggests costs paid by the offspring if mothers predict environmental conditions wrongly.