Swiss pilot low-dose computed tomography lung cancer screening study

Objective

Low-dose computed tomography (LDCT) lung cancer screening is endorsed by US guidelines and has recently been shown effective in a large European randomized controlled trial. Nevertheless, actual realization of a lung cancer screening program is challenging and depends on country-specific factors. This pilot study aimed to evaluate implementation, execution, and performance of LDCT lung cancer screening in Switzerland.

Methods

Since October 2018, asymptomatic participants aged 55–74 years with more than 30 pack-years smoking history were enrolled at a tertiary hospital in Switzerland. Participants with history of lung cancer, major (palliative) health problems or those that had a thorax CT scan 18 months prior to enrollment were excluded. First, we evaluated lung cancer risk according to NLST guidelines. Second, we estimated lung cancer risk using the PLCOm2012 model risk calculator with threshold of 5%. Lung nodules were assessed according to Lung-RADS (Version 1.1. 2019). Participants were recruited through flyers, a newspaper article and pulmonary specialists. Screening consisted of one LDCT-scan, follow-up was recommended for suspicious nodules only. LDCT assessment was performed by two radiologists, one of them a board certified chest radiologist. Enrollment and follow-up are currently ongoing.

Results

To date, 75 participants (25 (33%) females) with a median age of 62 years (interquartile range [IQR] 56–67 years) were included. Median number of pack years smoked was 49 (IQR 41–58 pack years). Median PLCOm2012 6-year lung cancer probability was 2.7% (IQR 2.6–2.9%), 19 (26%) participants had stopped smoking before enrollment. 6 participants required follow up imaging of suspect nodules, resulting in a recall rate of 8%. At baseline, lung cancer was found in 2 (2.7%, one squamous cell (stage IIIA) and one adenocarcinoma (stage IV)) participants.

Conclusion

In this Swiss LDCT lung cancer screening pilot study using modified inclusion criteria, 2.7% were diagnosed with lung cancer to date.

Failure of Ceftriaxone in an Intravenous Drug User with Invasive Infection Due to Ralstonia pickettii

We report a case of septic arthritis due to Ralstonia pickettii in an intravenous drug user with unfavorable clinical course under antibiotic therapy with ceftriaxone despite in vitro susceptibility to the drug. The treatment failure may have been due to a discrepancy between in vitro and in vivo susceptibility of R. pickettii, or to resistance development mediated by a recently described inducible beta-lactamase.

Two high-speed, portable GC systems designed for the measurement of non-methane hydrocarbons and PAN: Results from the Jungfraujoch High Altitude Observatory

Near real-time measurements of light non-methane hydrocarbons (NMHCs) and peroxyacetyl nitrate (PAN) have been performed in the free troposphere using two fast gas chromatography (GC) instruments designed for use on aircraft. A GC-helium ionisation detector (HID) system measured 15 C(2)-C(5) hydrocarbons with 5 min time resolution and a dual channel GC-Electron Capture Detector (ECD) measured PAN with 90 s resolution. Both instruments had low parts per trillion by volume (pptV) detection limits and ran continuously at the remote Jungfraujoch (JFJ) research station in the Swiss Alps (46.55[degree]N, 7.98[degree]E), 3580 m above mean sea level (AMSL), during February/March 2003. Carbon monoxide, ozone, nitrogen oxide and nitrogen dioxide and all odd nitrogen species (NO(y)) were also measured continuously. Hydrocarbons and CO were strongly correlated in all air-masses whilst PAN exhibited both positive and negative correlations with respect to O(3), dependent on age and origin of the air-mass sampled. PAN was found to contribute [similar]20% to the NO(y) sampled on average. The experiment, as well as providing interesting datasets from this remote location, also demonstrated that when optimised, GC techniques have the potential to measure at a time resolution significantly greater than is traditionally considered, with high sensitivity and low uncertainty.

[Candida albicans endocarditis. A rare disease with serious complications]

HISTORY AND ADMISSION FINDINGS

A 54-year-old farmer with moderate mitral valve regurgitation was admitted to hospital because of suspected infective endocarditis.

EXAMINATIONS

Echocardiography revealed a large mitral valve vegetation as the source of multifocal septic emboli to the central nervous system, spleen, mesenteric and femoro-popliteal arteries, eyes, and kidneys. Eventually an embolus removed from the femoro-popliteal artery and vegetations on the replaced mitral valve grew C. albicans.

THERAPY

Despite treatment with amphotericin B and valve replacement the patient died of septicemia due to E. coli.

CONCLUSION

Endocarditis due to C. albicans is commonly associated with severe complications. Diagnosis of this rare disease is often delayed because of negative blood cultures. Large cardiac vegetations and embolization of major arterial vessels should raise the suspicion of fungal endocarditis.

[Antibiotic resistance: infections of the upper respiratory tract and bronchi. When are antibiotics necessary?]

Antimicrobial resistance among respiratory tract pathogens has become an increasing problem worldwide during the last 10-20 years. The wide use of antimicrobial agents in ambulatory practice has contributed to the emergence and spread of antibiotic-resistant bacteria in the community, namely Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. The pneumococcus has developed resistance to most antibiotics used for its treatment. Classes with important resistance problems include the beta-lactams, the macrolides, the lincosamides, trimethoprim-sulfamethoxazole, and the tetracyclines. Unfortunately, resistance to more than one class of antibiotics is common. In Haemophilus influenzae and Moraxella catarrhalis, resistance to beta-lactam antibiotics is the main concern currently. It is important to know the local resistance pattern of the most common respiratory tract pathogens in order to make reasonable recommendations for an empirical therapy for respiratory tract infection, when antibiotic therapy is indeed indicated.