[Meningitis (I)--differential diagnosis; aseptic and chronic meningitis].

Meningitis is the most common serious manifestation of infection of the central nervous system. Inflammatory involvement of the subarachnoid space with meningeal irritation leads to the classical triad of headache, fever, and meningism, and to a pleocytosis of the cerebrospinal fluid (CSF). Meningitis is clinically categorized into an acute and chronic disease based on the acuity of symptoms. Acute meningitis develops over hours to days, while in chronic meningitis symptoms evolve over days or even weeks. Aseptic meningitis, in which no bacterial pathogen can be isolated by routine cultures, can mimic bacterial meningitis, but the disease has a much more favorable prognosis. Many cases of aseptic meningitis are caused by viruses, primarily enteroviruses, but bacteria and noninfectious etiologies also cause meningitis with negative cultures. Symptoms of meningeal inflammation with CSF pleocytosis that persist for more than 4 weeks define the chronic meningitis syndrome. The diagnosis is based on the patient history, clinical evidence of meningitis, CSF examination, and often imaging studies. The differential diagnosis is broad, and the predominant CSF cell type can provide clues as to the underlying disease. Empiric therapy is primarily based on the age of the patient, with modifications if there are positive findings on CSF gram stain or if the patient presents with special risk factors. In patients with chronic meningitis, a definite diagnosis is often not available or delayed for days, in which case empiric therapy may have to be initiated. It is important to cover the treatable causes of meningitis, for which the outcome is poor if treatment is delayed.

Estilos en las redes sociales en línea: un estudio basado en corpora

Das Internet wird ein immer populäreres und wichtigeres Kommunikationsmittel, besonders die sogenannten Social-Networking-Sites. In dieser Studie wird untersucht wie die Social-Networking-Sites, Facebook und Tuenti, die Kommunikation beeinflussen. In einem Korpus von Usern aus Málaga, wurde der Gebrauch von nicht-Standard Merkmalen analysiert und mit dem in der gesprochenen Sprache verglichen. Aus diesem Vergleich lässt sich schließen, dass die untersuchten sozialen und linguistischen Faktoren in der virtuellen und der reellen Sprache unterschiedlich funktionieren. Aufgrund dieses unterschiedlichen Gebrauchs kann die elektronische Kommunikation Facebook und Tuenti’s als Stil betrachtet werden, welcher den Usern dazu dient, soziale Bedeutung zu kreieren und ihre sprachliche Identität auszudrücken.

International variation in GP treatment strategies for subclinical hypothyroidism in older adults: a case-based survey

Background: There is limited evidence about the impact of treatment for subclinical hypothyroidism, especially among older people. Aim: To investigate the variation in GP treatment strategies for older patients with subclinical hypothyroidism depending on country and patient characteristics. Design and setting: Case-based survey of GPs in the Netherlands, Germany, England, Ireland, Switzerland, and New Zealand. Method: The treatment strategy of GPs (treatment yes/no, starting-dose thyroxine) was assessed for eight cases presenting a woman with subclinical hypothyroidism. The cases differed in the patient characteristics of age (70 versus 85 years), vitality status (vital versus vulnerable), and thyroid-stimulating hormone (TSH) concentration (6 versus 15 mU/L). Results: A total of 526 GPs participated (the Netherlands n = 129, Germany n = 61, England n = 22, Ireland n = 21, Switzerland n = 262, New Zealand n = 31; overall response 19%). Across countries, differences in treatment strategy were observed. GPs from the Netherlands (mean treatment percentage 34%), England (40%), and New Zealand (39%) were less inclined to start treatment than GPs in Germany (73%), Ireland (62%), and Switzerland (52%) (P = 0.05). Overall, GPs were less inclined to start treatment in 85-year-old than in 70-year-old females (pooled odds ratio [OR] 0.74 [95% confidence interval [CI] = 0.63 to 0.87]). Females with a TSH of 15 mU/L were more likely to get treated than those with a TSH of 6 mU/L (pooled OR 9.49 [95% CI = 5.81 to 15.5]). Conclusion: GP treatment strategies of older people with subclinical hypothyroidism vary largely by country and patient characteristics. This variation underlines the need for a new generation of international guidelines based on the outcomes of randomised clinical trials set within primary care

Annäherung an die soziale Wirklichkeit der SS-Ärzte. Sprachanalysen und sozialpsychologische Untersuchungen anhand von Hans Münchs Erinnerungserzählungen

Die Arbeit untersucht, wie Tätererinnerungen für die Geschichtswissenschaft nutzbar gemacht werden können. Hans Münch, ein ehemaliger SS-Arzt in Auschwitz, hat sein Leben lang zahlreiche Interviews gegeben. Diese werden einer Sprach- und Diskursanalyse unterzogen und aus sozialpsychologischer Perspektive betrachtet. Dabei wird deutlich, wie die Methodenwahl die Ergebnisse mitbestimmt. Strukturelemente und Rahmenbedingungen, die das Denken und Handeln Münchs beeinflusst haben, werden herausgearbeitet. Dadurch werden die soziale Wirklichkeit der SS-Ärzte sowie die Beweggründe für diesen Genozid auf der Täterebene greifbarer gemacht. Es wird aufgezeigt, wie Münch Brüche in seiner Lebensgeschichte mit einem konsistenten Selbstbild, einer Sinnkonstruktion, zu überdecken versuchte.

Replication and fine-mapping of a QTL for recurrent airway obstruction in European Warmblood horses.

Recurrent airway obstruction (RAO), or 'heaves', is a common performance-limiting allergic respiratory disease of mature horses. It is related to sensitization and exposure to mouldy hay and has a familial basis with a complex mode of inheritance. In a previous study, we detected a QTL for RAO on ECA 13 in a half-sib family of European Warmblood horses. In this study, we genotyped additional markers in the family and narrowed the QTL down to about 1.5 Mb (23.7-25.2 Mb). We detected the strongest association with SNP BIEC2-224511 (24,309,405 bp). We also obtained SNP genotypes in an independent cohort of 646 unrelated Warmblood horses. There was no genome-wide significant association with RAO in these unrelated horses. However, we performed a genotypic association study of the SNPs on ECA 13 in these unrelated horses, and the SNP BIEC2-224511 also showed the strongest association with RAO in the unrelated horses (p(raw) = 0.00037). The T allele at this SNP was associated with RAO both in the family and the unrelated horses. Thus, the association study in the unrelated animals provides independent support for the previously detected QTL. The association study allows further narrowing of the QTL interval to about 0.5 Mb (24.0-24.5 Mb). We sequenced the coding regions of the genes in the critical region but did not find any associated coding variants. Therefore, the causative variant underlying this QTL is likely to be a regulatory mutation.