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Our study aim was to determine how a new clinical pathway, including PCR‐based influenza point‐of‐care test (POCT), influences the hospitalisation costs of patients suspected of influenza presenting at the emergency department of a Dutch hospital during two consecutive influenza epidemics (2016‐2017 and 2017‐2018). Compared to mean costs per patient of €3661 in 2016‐2017, the implementation of this new clinical pathway with influenza POCT in 2017 was associated with mean costs per influenza‐positive patient of €2495 in 2017‐2018 (P =.3). Our study suggests favourable economic results regarding a new clinical pathway with influenza POCT, reflecting a more efficient care of patients suspected of influenza presenting at the emergency department. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe specific histological findings of the Coxiella burnetii-infected aneurysmal abdominal aortic wall. Tissue samples of the aneurysmal abdominal aortic wall from seven patients with chronic Q fever and 15 patients without evidence of Q fever infection were analysed and compared. Chronic Q fever was diagnosed using serology and tissue PCR analysis. Histological sections were stained using haematoxylin and eosin staining, Elastica van Gieson staining and immunohistochemical staining for macrophages ( CD68), T lymphocytes ( CD3), T lymphocyte subsets (CD4 and CD8) and B lymphocytes ( CD20). Samples were scored by one pathologist, blinded for Q fever status, using a standard score form. Seven tissue samples from patients with chronic Q fever and 15 tissue samples from patients without Q fever were collected. Four of seven chronic Q fever samples showed a necrotizing granulomatous response of the vascular wall, which was characterized by necrotic core of the arteriosclerotic plaque ( P = 0.005) and a presence of high numbers of macrophages in the adventitia ( P = 0.007) distributed in typical palisading formation ( P = 0.005) and surrounded by the presence of high numbers of T lymphocytes located diffusely in media and adventitia. Necrotizing granulomas are a histological finding in the C. burnetii-infected aneurysmal abdominal aortic wall. Chronic Q fever should be included in the list of infectious diseases with necrotizing granulomatous response, such as tuberculosis, cat scratch disease and syphilis. [ABSTRACT FROM AUTHOR]

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BACKGROUND: In 2007, 2008, and 2009 outbreaks of Q-fever occurred in the Netherlands with increasing magnitude. The 2009 outbreak with 2354 reported cases is the largest human Q-fever outbreak ever recorded. To assess the extent of infection and the safety of donated blood, we tested local blood donations for presence of Coxiella burnetii antibodies and DNA. STUDY DESIGN AND METHODS: Starting May 2009, more than 40,000 serum samples were collected from all consenting blood donors in the areas with high Q-fever incidence. The 1004 samples from the areas with the highest number of reported cases were tested for C. burnetii DNA by polymerase chain reaction; seroprevalence and incidence were determined using enzyme-linked immunosorbent assay and immunofluorescence assays (IFAs) in the subset of 543 donors of whom a follow-up sample was available. RESULTS: A total of 6 of 1004 donor samples tested reactive for C. burnetii DNA. Confirmatory testing (IFA) on the index and follow-up samples demonstrated seroconversion in two donors, high-level preexisting antibodies in one donor, and no seroconversion in three donors. Immunoglobulin (Ig)G testing of the 543 serum pairs showed that 66 were reactive in the latest sample, of which 10 represented seroconversions. CONCLUSION: In the area with highest incidence during a large Q-fever outbreak, 3 of 1004 blood donations contained C. burnetii DNA (0.3%; 95% confidence interval, 0.1%-1.0%). A total of 66 of 543 (12.2%) donors tested positive for anti- Coxiella IgG. Ten seroconversions were detected, resulting in an incidence of 5.7% per year, which is more than 10-fold higher than the local number of reported clinical cases (0.47% per year). [Correction added after online publication 14-Jul-11: high-level existing antibodies has been updated to highlevel preexisting antibodies.] [ABSTRACT FROM AUTHOR]

The article presents a research which analyzes the phenomenon of resistance to coumarin derivatives like phenprocoumon, in patients who are given phenprocoumon for long-term prevention of thromboembolic events. According to the researchers, coumarins act by inhibiting the vitamin K epoxide reductase (VKOR), encoded for by the VKORC1 (VKOR complex, subunit 1) gene, however some VKORC1 genetic variants confer coumarin resistance.