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Cerebral Aspergillosis with Multiple Enhancing Nodules in the Right Cerebral Hemisphere in the Immune-Competent Patient
Lee, Gwang-Jun
Jung, Tae-Young
Choi, Seong-Min
Jung, Min-Young
Journal of Korean Neurosurgical Society
Aspergillosis in the central nervous system (CNS) is a very rare disease in immune-competent patients. There was a case of a healthy man without a history of immune-compromised disease who had invasive aspergillosis with unusual radiologic findings. A 48-year-old healthy man with diabetes mellitus, presented with complaints of blurred vision that persisted for one month. Brain magnetic resonance imaging (MRI) showed multiple nodular enhancing lesions on the right cerebral hemisphere. The diffusion image appeared in a high-signal intensity in these areas. Cerebrospinal fluid examination did not show any infection signs. An open biopsy was done and intraoperative findings showed grayish inflammatory and necrotic tissue without a definitive mass lesion. The pathologic result was a brain abscess caused by fungal infection, morphologically aspergillus. Antifungal agents (Amphotericin B, Ambisome and Voriconazole) were used for treatment for 3 months. The visual symptoms improved. There was no recurrence or abscess pocket, but the remaining focal enhanced lesions were visible in the right temporal and occipital area at a one year follow-up MRI. This immune-competent patient showed multiple enhancing CNS aspergillosis in the cerebral hemisphere, which had a good outcome with antifungal agents.
Aspergillosis; Cerebral; Enhancement; Immune-competent; Multiple
Related Articles
Emergence of Azole Resistance in Aspergillus fumigatus and Spread of a Single Resistance Mechanism
Snelders, Eveline
van der Lee, Henrich A. L
Kuijpers, Judith
Rijs, Anthonius J. M. M
Varga, János
Samson, Robert A
Mellado, Emilia
Donders, A. Rogier T
Melchers, Willem J. G
Verweij, Paul E
PLoS Medicine
Resistance to triazoles was recently reported in Aspergillus fumigatus isolates cultured from patients with invasive aspergillosis. The prevalence of azole resistance in A. fumigatus is unknown. We investigated the prevalence and spread of azole resistance using our culture collection that contained A. fumigatus isolates collected between 1994 and 2007.
Methods and Findings
We investigated the prevalence of itraconazole (ITZ) resistance in 1,912 clinical A. fumigatus isolates collected from 1,219 patients in our University Medical Centre over a 14-y period. The spread of resistance was investigated by analyzing 147 A. fumigatus isolates from 101 patients, from 28 other medical centres in The Netherlands and 317 isolates from six other countries. The isolates were characterized using phenotypic and molecular methods. The electronic patient files were used to determine the underlying conditions of the patients and the presence of invasive aspergillosis. ITZ-resistant isolates were found in 32 of 1,219 patients. All cases were observed after 1999 with an annual prevalence of 1.7% to 6%. The ITZ-resistant isolates also showed elevated minimum inhibitory concentrations of voriconazole, ravuconazole, and posaconazole. A substitution of leucine 98 for histidine in the cyp51A gene, together with two copies of a 34-bp sequence in tandem in the gene promoter (TR/L98H), was found to be the dominant resistance mechanism. Microsatellite analysis indicated that the ITZ-resistant isolates were genetically distinct but clustered. The ITZ-sensitive isolates were not more likely to be responsible for invasive aspergillosis than the ITZ-resistant isolates. ITZ resistance was found in isolates from 13 patients (12.8%) from nine other medical centres in The Netherlands, of which 69% harboured the TR/L98H substitution, and in six isolates originating from four other countries.
Azole resistance has emerged in A. fumigatus and might be more prevalent than currently acknowledged. The presence of a dominant resistance mechanism in clinical isolates suggests that isolates with this mechanism are spreading in our environment.
Editors' Summary
Aspergillosis is a group of lung diseases caused by infection with Aspergillus, a mold (fungus) that grows on decaying plant matter. Because Aspergillus is widespread in the environment, people often breathe in its spores. For most people, this is not a problem—their immune system rapidly kills the fungal spores. However, people with asthma or cystic fibrosis sometimes develop allergic bronchopulmonary aspergillosis, a condition in which the spores trigger an allergic reaction in the lungs that causes coughing, wheezing. and breathlessness. Other people can develop an aspergilloma—a fungus ball that grows in cavities in the lung caused by other illnesses such as tuberculosis. However, the most serious form of aspergillosis is invasive aspergillosis. This pneumonia-like infection, which is fatal if left untreated, affects people who have a weakened immune system (for example, people with leukemia) and can spread from the lungs into the heart, brain, and other parts of the body. Aspergillosis is usually treated with triazole drugs, which inhibit an enzyme that the fungus needs to make its cell membranes; this enzyme is encoded by a gene called cyp51A. Voriconazole is the first-line therapy for aspergillosis but itraconazole and posaconazole are also sometimes used and ravuconazole is in clinical development.
Why Was This Study Done?
About half of patients with invasive aspergillosis recover if they are given triazoles. Worryingly, however, strains of Aspergillus fumigatus (the type of Aspergillus usually involved in invasive aspergillosis) with resistance to several triazoles have recently been isolated from some patients in The Netherlands. If multi-azole resistant strains of A. fumigatus become common, they could have a serious impact on the management of invasive aspergillosis. However, noone knows what proportion of A. fumigatus strains isolated from patients with aspergillosis are resistant to several azole drugs. That is, noone knows the "prevalence" of multi-azole resistance. In this study, the researchers investigate the prevalence and development of azole resistance in A. fumigatus.
What Did the Researchers Do and Find?
Since 1994, all fungal isolates from patients at the Radboud University Nijmegen Medical Center in the Netherlands have been stored. The researchers' search of this collection yielded 1,908 A. fumigatus isolates that had been collected from 1,219 patients over a 14-year period. Of these, the isolates from 32 patients grew in the presence of itraconazole. All the itraconazole-resistant isolates (which also had increased resistance to voriconazole, ravuconazole, and posaconazole) were collected after 1999; the annual prevalence of itraconazole-resistant isolates ranged from 1.7% to 6%. The researchers then sequenced the cyp51A gene in each resistant isolate. Thirty had a genetic alteration represented as TR/L98H. This "dominant resistance mechanism" consisted of a single amino acid change in the cyp51A gene and an alteration in the gene's promoter region (the region that controls how much protein is made from a gene). The researchers also analyzed A. fumigatus isolates from patients admitted to 28 other hospitals in the Netherlands. Itraconazole resistance was present in isolates from 13 patients (out of 101 patients) from nine hospitals; the TR/L98H genetic alteration was present in 69% of the itraconazole-resistant isolates. Finally, itraconazole resistance was present in six isolates from four other countries (out of 317 isolates from six countries); only one Norwegian isolate had the TR/L98H genetic alteration.
What Do These Findings Mean?
These findings indicate that azole resistance is emerging in A. fumigatus and may already be more prevalent than generally thought. Given the dominance of the TR/L98H genetic alteration in the azole-resistant clinical isolates, the researchers suggest that A. fumigatus isolates harboring this alteration might be present and spreading in the environment rather than being selected for during azole treatment of patients. Why azole resistance should develop in A. fumigatus in the environment is unclear but might be caused by the use of azole-containing fungicides. Further studies are now urgently needed to find out if this is the case, to measure the international prevalence and spread of A. fumigatus isolates harboring the TR/L98H genetic alteration, and, most importantly, to develop alternative treatments for patients with azole-resistant aspergillosis.
Additional Information.
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0050219.
The MedlinePlus Medical Encyclopedia has a page on aspergillosis (in English and Spanish)
The UK National Health Service Direct health encyclopedia has detailed information about all aspects of aspergillosis
The US Centers for Disease Control and Prevention also has information about aspergillosis
Paul Verweij and colleagues show that azole resistance has emerged inAspergillus fumigatus in The Netherlands and that a dominant resistance mechanism is present in clinical isolates.
Related Articles
Cranial aspergilloma masquerading as meningioma
Verma, Ritu
Singh, Prabhat
Kumar, Achal
Paliwal, Vimal Kumar
BMJ Case Reports
Cranial aspergillosis may present as meningitis, cerebral abscess, cerebral infarcts/haemorrhages or extra-axial mass. Extra-axial cranial aspergilloma may mimic meningioma owing to mass-like characteristics and intense contrast enhancement on MRI there by delaying the diagnosis and further worsening the already bad prognosis in these patients. We present a 45-year-old gentleman who presented with signs of raised intracranial hypertension, secondary optic atrophy and a contrast-enhancing mass arising from the planum sphenoidale. Postoperatively, mass was diagnosed as aspergilloma on histopathology and culture. Despite antifungal treatment, patient could not be saved due to large artery infarcts in the immediate postoperative period. We discuss the clinical and MRI features that could help to have sufficient and early suspicion of fungal aetiology in these patients.
Related Articles
A Case of Acute Cerebral Aspergillosis Complicating Influenza A/H1N1pdm 2009
Kim, Min Jae
Kim, Min-Kyung
Kang, Chang Kyung
Jun, Kang Il
Bang, Ji-Hwan
Park, Sang-Won
Oh, Myoung-don
Infection & Chemotherapy
Invasive aspergillosis is a rare complication in patients with influenza infection. Several cases of invasive pulmonary aspergillosis accompanying influenza infections were reported during the influenza A/H1N1pdm 2009. We encountered a case of acute cerebral aspergillosis in a patient with influenza A/H1N1pdm 2009 infection. A 24-year-old man with uncontrolled diabetes was diagnosed with influenza A/H1N1pdm 2009 infection. Initial evaluation indicated methicillin-sensitive Staphylococcus aureus pneumonia and diabetic ketoacidosis along with influenza. During his hospital course, multiple new rim-enhancing mass lesions not evident in the initial evaluation developed in the fronto-parietal cortical and subcortical white matter and right cerebellum. Pathology and culture results confirmed the presence of Aspergillus fumigatus. Surgical drainage combined with a total of 18 weeks of antifungal therapy resulted in complete resolution of the infection. This case demonstrates that cerebral aspergillosis can present alongside influenza in patients with diabetes or those under intensive care. Clinical suspicion of invasive aspergillosis is required for a definite diagnosis and better prognosis in such cases.
Central nervous system; Invasive aspergillosis; Influenza; Brain abscess; Diabetes mellitus
Related Articles
Invasive maxillary sinus aspergillosis: A case report successfully treated with voriconazole and surgical debridement
Peral-Cagigal, Beatriz
Redondo-González, Luis-Miguel
Verrier-Hernández, Alberto
Journal of Clinical and Experimental Dentistry
Introduction: Invasive aspergillosis of the paranasal sinuses is a rare disease and often misdiagnosed; however, its incidence has seen substancial growth over the past 2 decades. Definitive diagnosis of these lesions is based on histological examination and fungal culture. Case Report: An 81-year-old woman with a history of pain in the left maxillary region is presented. The diagnosis was invasive maxillary aspergillosis in immunocompetent patient, which was successfully treated with voriconazole and surgical debridement. Possible clinical manifestations, diagnostic imaging techniques and treatment used are discussed. Since the introduction of voriconazole, there have been several reports of patients with invasive aspergillosis who responded to treatment with this new antifungal agent. Conclusions: We report the importance of early diagnosis and selection of an appropriate antifungal agent to achieve a successful treatment.
Key words:Invasive aspergillosis, voriconazole, fungal sinusitis, antifungal agent, open sinus surgery.
Related Articles
Invasive Aspergillosis in a Renal Transplant Recipient Successfully Treated with Interferon-Gamma
Estrada, C.
Desai, A. G.
Chirch, L. M.
Suh, H.
Seidman, R.
Darras, F.
Nord, E. P.
Case Reports in Transplantation
Invasive aspergillosis is a serious complication of solid organ transplantation. An early diagnosis is hampered by the lack of reliable serum markers and, even if appropriately diagnosed and treated with current antifungal agents, has a high mortality rate. We report a case of invasive pulmonary and cerebral aspergillosis in a renal transplant patient treated with IFN-γ in conjunction with combination anti-fungal therapy for six weeks in whom complete resolution of the fungal infection was achieved. Renal function remained intact throughout the treatment period. Surveillance CT scans of the chest and head showed resolution of prior disease but revealed a new left upper lobe mass four months after completion of treatment with IFN-γ. Biopsy of the lesion was positive for primary lung adenocarcinoma, for which she underwent left upper lobe resection. The pathology report confirmed clear surgical margins and lymph nodes and no evidence of fungal hyphae. IFN-γ should be considered early in the management of invasive aspergillosis in renal transplant patients. To date, allograft rejection has not been encountered.
Related Articles
Repeated Aspergillus isolation in respiratory samples from non-immunocompromised patients not selected based on clinical diagnoses: colonisation or infection?
Barberan, Jose
Alcazar, Bernardino
Malmierca, Eduardo
Garcia de la Llana, Francisco
Dorca, Jordi
del Castillo, Daniel
Villena, Victoria
Hernandez-Febles, Melissa
Garcia-Perez, Francisco-Javier
Granizo, Juan-Jose
Gimenez, Maria-Jose
Aguilar, Lorenzo
BMC Infectious Diseases
Isolation of Aspergillus from lower respiratory samples is associated with colonisation in high percentage of cases, making it of unclear significance. This study explored factors associated with diagnosis (infection vs. colonisation), treatment (administration or not of antifungals) and prognosis (mortality) in non-transplant/non-neutropenic patients showing repeated isolation of Aspergillus from lower respiratory samples.
Records of adult patients (29 Spanish hospitals) presenting ≥2 respiratory cultures yielding Aspergillus were retrospectively reviewed and categorised as proven (histopathological confirmation) or probable aspergillosis (new respiratory signs/symptoms with suggestive chest imaging) or colonisation (symptoms not attributable to Aspergillus without dyspnoea exacerbation, bronchospasm or new infiltrates). Logistic regression models (step–wise) were performed using Aspergillosis (probable + proven), antifungal treatment and mortality as dependent variables. Significant (p < 0.001) models showing the highest R2 were considered.
A total of 245 patients were identified, 139 (56.7%) with Aspergillosis. Aspergillosis was associated (R2 = 0.291) with ICU admission (OR = 2.82), congestive heart failure (OR = 2.39) and steroids pre-admission (OR = 2.19) as well as with cavitations in X-ray/CT scan (OR = 10.68), radiological worsening (OR = 5.22) and COPD exacerbations/need for O2 interaction (OR = 3.52). Antifungals were administered to 79.1% patients with Aspergillosis (100% proven, 76.8% probable) and 29.2% colonised, with 69.5% patients receiving voriconazole alone or in combination. In colonised patients, administration of antifungals was associated with ICU admission at hospitalisation (OR = 12.38). In Aspergillosis patients its administration was positively associated (R2 = 0.312) with bronchospasm (OR = 9.21) and days in ICU (OR = 1.82) and negatively with Gold III + IV (OR = 0.26), stroke (OR = 0.024) and quinolone treatment (OR = 0.29). Mortality was 78.6% in proven, 41.6% in probable and 12.3% in colonised patients, and was positively associated in Aspergillosis patients (R2 = 0.290) with radiological worsening (OR = 3.04), APACHE-II (OR = 1.09) and number of antibiotics for treatment (OR = 1.51) and negatively with species other than A. fumigatus (OR = 0.14) and aspergillar tracheobronchitis (OR = 0.27).
Administration of antifungals was not always closely linked to the diagnostic categorisation (colonisation vs. Aspergillosis), being negatively associated with severe COPD (GOLD III + IV) and concomitant treatment with quinolones in patients with Aspergillosis, probably due to the similarity of signs/symptoms between this entity and pulmonary bacterial infections.
Aspergillus; COPD; Clinical management; Aspergillosis
Related Articles
PCR based identification and discrimination of agents of mucormycosis and aspergillosis in paraffin wax embedded tissue
Bialek, R
Konrad, F
Kern, J
Aepinus, C
Cecenas, L
Gonzalez, G M
Just-Nübling, G
Willinger, B
Presterl, E
Lass-Flörl, C
Rickerts, V
Journal of Clinical Pathology
Background: Invasive fungal infections are often diagnosed by histopathology without identification of the causative fungi, which show significantly different antifungal susceptibilities.
Aims: To establish and evaluate a system of two seminested polymerase chain reaction (PCR) assays to identify and discriminate between agents of aspergillosis and mucormycosis in paraffin wax embedded tissue samples.
Methods: DNA of 52 blinded samples from five different centres was extracted and used as a template in two PCR assays targeting the mitochondrial aspergillosis DNA and the 18S ribosomal DNA of zygomycetes.
Results: Specific fungal DNA was identified in 27 of 44 samples in accordance with a histopathological diagnosis of zygomycosis or aspergillosis, respectively. Aspergillus fumigatus DNA was amplified from one specimen of zygomycosis (diagnosed by histopathology). In four of 16 PCR negative samples no human DNA was amplified, possibly as a result of the destruction of DNA before paraffin wax embedding. In addition, eight samples from clinically suspected fungal infections (without histopathological proof) were examined. The two PCR assays detected a concomitant infection with Absidia corymbifera and A fumigatus in one, and infections with Rhizopus arrhizus and A fumigatus in another two cases.
Conclusions: The two seminested PCR assays described here can support a histopathological diagnosis of mucormycosis or aspergillosis, and can identify the infective agent, thereby optimising antifungal treatment.
mucormycosis; aspergillosis; zygomycetes; polymerase chain reaction
Related Articles
Refractory invasive aspergillosis controlled with posaconazole and pulmonary surgery in a patient with chronic granulomatous disease: case report
Kepenekli, Eda
Soysal, Ahmet
Kuzdan, Canan
Ermerak, Nezih Onur
Yüksel, Mustafa
Bakır, Mustafa
Italian Journal of Pediatrics
Invasive aspergillosis is an important cause of morbidity and mortality in immunocompromised patients. Among primary immunodefiencies, chronic granulomatous disease (CGD) has the highest prevalence of invasive fungal diseases. Voriconazole is recommended for the primary treatment of invasive aspergillosis in most patients. In patients whose aspergillosis is refractory to voriconazole, therapeutic options include changing class of antifungal, for example using an amphotericin B formulation, an echinocandin, combination therapy, or further use of azoles. Posaconazole is a triazole derivative which is effective in Aspergillosis prophylaxis and treatment. Rarely, surgical therapy may be needed in some patients. Lesions those are contiguous with the great vessels or the pericardium, single cavitary lesion that cause hemoptysis, lesions invading the chest wall, aspergillosis that involves the skin and the bone are the indications for surgical therapy.
Chronic granulomatous disease (CGD) is an inherited immundeficiency caused by defects in the phagocyte nicotinamide adenine dinucleotidephosphate (NADPH) oxidase complex which is mainstay of killing microorganisms. CGD is characterized by recurrent life-threatening bacterial and fungal infections and by abnormally exuberant inflammatory responses leading to granuloma formation, such as granulomatous enteritis, genitourinary obstruction, and wound dehiscence. The diagnosis is made by neutrophil function testing and the genotyping.
Herein, we present a case with CGD who had invasive pulmonary aspergillosis refractory to voriconazole and liposomal amphotericine B combination therapy that was controlled with posaconazole treatment and pulmonary surgery.
Chronic granulomatous disease; Invasive pulmonary aspergillosis; Posaconazole
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A comparative clinicopathologic study of endogenous mycotic endophthalmitis: variations in clinical and histopathologic changes in candidiasis compared to aspergillosis.
Rao, N A
Hidayat, A
Transactions of the American Ophthalmological Society
PURPOSE: Endophthalmitis caused by endogenous Candida and Aspergillus species has emerged as a visually threatening complication in patients with immune deficiency of various causes. Twenty-five patients who underwent enucleation, 13 with endogenous Aspergillus endophthalmitis and 12 with endogenous Candida intraocular infections, were evaluated. Both clinical features and intraocular spread of the fungi were studied to determine which clinical and/or histopathologic features could help distinguish aspergillosis from Candida infections. METHODS: Clinical information was sought from each case to determine whether there was any underlying systemic condition and to delineate the characteristic clinical features seen at initial presentation. The results of vitreous and other tissue cultures for bacteria and fungi were evaluated. Patients with AIDS were excluded. The enucleated globes were processed for histopathologic analysis to detect location of the fungal elements, inflammatory response, and vascular invasion by the fungi. RESULTS: With respect to the various predisposing systemic conditions, Candida species endophthalmitis was noted in patients with a history of gastrointestinal surgery, hyperalimentation, or diabetes mellitus, whereas aspergillosis was present in patients who had undergone organ transplantation or cardiac surgery. The vitreous was the primary focus of infection for Candida, whereas subretinal or sub-retinal pigment epithelium infection was noted in eyes with aspergillosis. Retinal and choroidal vessel wall invasion by fungal elements was noted in cases of aspergillosis but not in cases with candidiasis. The high rate of cerebral and cardiac infection in patients with Aspergillus endophthalmitis was not seen in those with Candida infection. CONCLUSIONS: The present study indicates that unlike Candida endophthalmitis, aspergillosis is seen in organ transplant or cardiac surgery patients, and its initial clinical presentation includes extensive areas of deep retinitis/choroiditis. Contrary to the findings in Candida endophthalmitis, vitreous biopsy may not yield positive results in aspergillosis. Aspergillus endophthalmitis is usually associated with a high rate of mortality caused by cerebral and cardiac complications.
Related Articles
Nasopharyngeal carcinoma presenting with rapidly progressive severe visual disturbance: a case report
Kamio, Yoshinobu
Sakai, Naoto
Takahashi, Goro
Baba, Satoshi
Namba, Hiroki
Journal of Medical Case Reports
Nasopharyngeal carcinoma is one of the most difficult tumors to diagnose correctly at the initial phase because of the occasional lack of nasal symptoms. The perineural spread of the trigeminal nerve is one of the most common and important routes in the intracranial paracavernous extension of nasopharyngeal carcinoma, but visual loss is very rare.
Case presentation
We report the case of a 54-year-old Japanese man with nasopharyngeal carcinoma, who presented with rapid and severe disturbance of left monocular visual acuity and eye movement with a 10-month history of ipsilateral otitis media and facial pain. Magnetic resonance imaging revealed a lesion in the left fossa of Rosenmüller, pterygopalatine fossa, sphenoid and ethmoid sinus, and the left cavernous sinus extending to the orbital apex through the superior orbital fissure. The histopathological diagnosis was nonkeratinizing undifferentiated nasopharyngeal carcinoma. Epstein–Barr virus was detected by in situ hybridization. Although focal radiotherapy induced remarkable tumor shrinkage and relieved ocular motor disturbance and facial pain, his visual acuity did not improve.
The awareness of cranial nerves in addition to intracranial and orbital apex involvement, as in this case, is important for appropriate diagnosis and treatment planning of nasopharyngeal carcinoma.
Cranial nerves; Epstein–Barr virus; Nasopharyngeal carcinoma; Orbital apex; Visual disturbance
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Cerebral aspergillosis in a patient with leprosy and diabetes: a case report
Segundo, João Batista Alves
da Silva, Marcos Antonio Custódio Neto
Filho, Walbert Edson Muniz
Nascimento, Anna Cyntia Brandão
Vidal, Flávia Castello Branco
Bezerra, Geusa Felipa de Barros
Viana, Graça Maria de Castro
Nascimento, Maria do Desterro Soares Brandão
BMC Research Notes
Opportunistic fungi are dispersed as airborne, ground and decaying matter. The second most frequent extra-pulmonary disease by Aspergillus is in the central nervous system.
Case presentation
The case subject was 55 years old, male, mulatto, and an assistant surveyor residing in Teresina, Piauí. He presented with headache, seizures, confusion, fever and left hemiparesis upon hospitalization in 2006 at Hospital São Marcos. Five years previously, he was diagnosed with diabetes mellitus, and 17 months previously he had acne margined by hyperpigmented areas and was diagnosed with leprosy. Laboratory tests indicated leukocytosis and magnetic resonance imaging showed an infarction in the right cerebral hemisphere. Cerebrospinal fluid examination showed 120 cells/mm3 and was alcohol-resistant bacilli negative. Trans-sphenoidal surgery with biopsy showed inflammation was caused by infection with Aspergillus fumigatus. We initiated use of parenteral amphotericin B, but his condition worsened. He underwent another surgery to implant a reservoir of Ommaya–Hickmann, a subcutaneous catheter. We started liposomal amphotericin B 5 mg/kg in the reservoir on alternate days. He was discharged with a prescription of tegretol and fluconazole.
This report has scientific interest because of the occurrence of angioinvasive cerebral aspergillosis in a diabetic patient, which is rarely reported. In conclusion, we suggest a definitive diagnosis of cerebral aspergillosis should not postpone quick effective treatment.
Cerebral aspergillosis; Leprosy; Diabetes; Mycotic arteritis; Aspergillus fumigatus
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Proven invasive pulmonary mucormycosis successfully treated with amphotericin B and surgery in patient with acute myeloblastic leukemia: a case report
Vidovic, Ana
Arsic-Arsenijevic, Valentina
Tomin, Dragica
Djunic, Irena
Jakovic, Radoslav
Loncar, Zlatibor
Barac, Aleksandra
Journal of Medical Case Reports
Invasive mucormycosis (zygomycosis) is the third most frequent fungal infection in patients with hematologic malignancies. It often results in a fatal outcome mainly due to the difficulty of early diagnosis and its resistance to antimycotics.
Case presentation
A 52-year-old Caucasian man was diagnosed with acute myeloblastic leukemia. Following the induction chemotherapy he developed febrile neutropenia. Meropenem (3×1000mg/day) was introduced empirically. A chest computed tomography showed soft-tissue consolidation change in his right upper lobe. A bronchoscopy was performed and the histology indicated invasive pulmonary aspergillosis based on fungal hypha detection. Also, high risk patients are routinely screened for invasive fungal infections using commercially available serological enzyme-linked immunosorbent assay tests: galactomannan and mannan (Bio-Rad, France), as well as anti-Aspergillus immunoglobulin G and/or immunoglobulin M and anti-Candida immunoglobulin G and/or immunoglobulin M antibodies (Virion-Serion, Germany). Galactomannan showed low positivity and voriconazole therapy (2×400mg/first day; 2×300mg/following days) was implemented. The patient became afebrile and a partial remission of disease was established. After 2 months, the patient developed a fever and a chest multi-slice computed tomography showed soft-tissue mass compressing his upper right bronchus. Voriconazole (2×400mg/first day; 2×300mg/following days) was reintroduced and bronchoscopy was repeated. Histologic examination of the new specimen was done, as well as a revision of the earlier samples in the reference laboratory and the diagnosis was switched to invasive pulmonary mucormycosis. The treatment was changed to amphotericin B colloidal dispersion (1×400mg/day). The complete remission of acute myeloblastic leukemia was verified after 2 months. During his immunerestitution, a high positivity of the anti-Aspergillus immunoglobulin M antibodies was found in a single serum sample and pulmonary radiography was unchanged. A lobectomy of his right upper pulmonary lobe was done and the mycology culture of the lung tissue sample revealed Rhizopus oryzae. He remained in complete remission for more than 1 year.
Invasive mucormycosis was successfully treated with amphotericin B, surgery and secondary itraconazole prophylaxis. As a rare disease invasive mucormycosis is not well understood by the medical community and therefore an improvement of education about prevention, diagnosis and treatment of invasive mucormycosis is necessary.
Acute myeloblastic leukemia; Early laboratory diagnosis; Invasive pulmonary mucormycosis
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Treatment of bronchopulmonary aspergillosis with observations on the use of natamycin
Henderson, A. H.
Pearson, J. E. G.
The problems of treatment in bronchopulmonary aspergillosis are discussed and illustrated by 11 case reports—four with aspergilloma, six with allergic aspergillosis, and two with probable allergic aspergillosis. A simple and effective treatment of aspergilloma, by local surgical evacuation of the cavity followed by irrigation with natamycin (Pimaricin), is described in three cases. Prior treatment of these cases with inhalations or intrabronchial instillations of natamycin was of doubtful benefit. The therapy of allergic aspergillosis is reviewed and an active approach is urged, based on the probable pathogenesis of the disease. This includes consideration of physical methods of removing bronchial plugs, mucolytic agents, steroids, and antifungal drugs given by aerosol in the absence of any that are suitable for systemic use. Steroids improved ventilatory function and were effective in resolving and preventing further episodes of pulmonary eosinophilia, but not usually in clearing the fungus from the bronchial tree, probably because permanent damage had already been sustained; they also carry the theoretical risk of allowing fungal invasion. Natamycin inhalations alone are considered of little value in the active disease, although their place in prophylaxis and when used with steroids remains to be evaluated. Mucolytic agents may help to clear the bronchial secretions, especially when these have become chronically impacted.
Related Articles
Localized primary renal aspergillosis in a diabetic patient following lithotripsy – a case report
Haq, Jalaluddin A
Khan, Mohammad AM
Afroze, Nazma
Haq, Tahniyah
BMC Infectious Diseases
Primary renal aspergillosis is rare in diabetic patients. Diagnosis of localized primary renal Aspergillus infection in diabetic patients requires careful investigations due to its benign presentation and lack of associated systemic clinical features. There is also paucity of information on the role of conservative treatment of such localized infection with antifungal agents only. Here, we describe a case of localized renal aspergillosis in a type 2 diabetic patient with a brief review of literature.
Case presentation
We describe a case of unilateral renal aspergillosis following intracorporeal pneumatic lithotripsy (ICPL) in a type 2 diabetic man. The patient presented with mild pain in the left lumbar region and periodic expulsion of whitish soft masses per urethra, which yielded growth of Aspergillus fumigatus. He was treated initially with amphotericin B; however, it was stopped after 2 weeks, as he could not tolerate the drug. Subsequently, he was successfully treated with oral itraconazole.
Localized renal aspergillosis may be suspected in diabetic patients having history of urinary tract instrumentation, mild lumbar pain, passage of suspicious masses in urine and persistent pyuria. Examination of the suspicious substances expelled per urethra is essential for diagnosis as routine multiple urine analysis may yield negative results. Conservative treatment with oral itraconazole alone is effective in cases with incomplete obstruction.
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A Congruous Superior Quadrantanopsia Following a Junctional Scotoma Induced by Asperogillosis
Park, In Ki
Lee, Seok Hyun
Chun, Yeoun Sook
Korean Journal of Ophthalmology : KJO
A 69-year old man presented to us with decreased vision in his right eye and a relative afferent pupillary defect. Under the presumption that he was suffering from retrobulbar optic neuritis or ischemic optic neuropathy, visual field tests were performed, revealing the presence of a junctional scotoma. Imaging studies revealed tumorous lesions extending from the sphenoid sinus at the right superior orbital fissure, with erosion of the right medial orbital wall and optic canal. Right optic nerve decompression was performed via an endoscopic sphenoidectomy, and histopathologic examination confirmed the presence of aspergillosis. The patient did not receive any postoperative antifungal treatment; however, his vision improved to 20 / 40, and his visual field developed a left congruous superior quadrantanopsia 18 months postoperatively. A junctional scotoma can be caused by aspergillosis, demonstrating the importance of examining the asymptomatic eye when a patient is experiencing a loss of vision in one eye. Furthermore, damage to the distal optic nerve adjacent to the proximal optic chiasm can induce unusual congruous superior quadrantanopsia.
Aspergillus; Hemianopsia; Optic nerve; Scotoma
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A Case of Invasive Pulmonary Aspergillosis with Direct Invasion of the Mediastinum and the Left Atrium in an Immunocompetent Patient
Han, Kyu-Hyun
Kim, Jung-Hyun
Shin, Sun Young
Jeong, Hye Yun
Chu, Ji Min
Kim, Hak Su
Kim, Daejin
Shim, Minjung
Cho, Sang-Ho
Kim, Eun Kyung
Tuberculosis and Respiratory Diseases
We report a case of invasive pulmonary aspergillosis invading the mediastinum and the left atrium. A 70-year-old woman was hospitalized for dyspnea. She had been well controlled for her diabetes mellitus and hypertension. The chest X-ray disclosed mediastinal widening, and the computed tomography scan of the chest showed that there was a large mediastinal mass and this lesion extended into the left atrium and right bronchus. The cardiac echocardiography showed that a huge mediastinal cystic mass compressed in the right atrium and a hyperechoic polypoid lesion in the left. The pathology from the bronchoscopic biopsy observed abundant fungal hyphae which was stained with periodic acid-Schiff and Gomori's methenamine silver. Despite the treatment with antifungal agents, she died from cardiac tamponade after three months. Invasive pulmonary aspergillosis, which involves the mediastinum and the heart, is very rare in immunocompetent patients.
Invasive Pulmonary Aspergillosis; Immunocompetence; Mediastinal Neoplasms; Heart Neoplasms
Related Articles
Dural arteriovenous fistula discovered in patient presenting with recent head trauma
Cooper, Chad J.
Said, Sarmad
Nunez, Angelica
Quansah, Raphael
Khalillullah, Sayeed
Hernandez, German T.
The American Journal of Case Reports
Male, 32
Final Diagnosis: Dural arterio-venous fistula
Symptoms: Eye redness • post-trauma headache • tinnitus
Medication: —
Clinical Procedure: Fistula embolization
Specialty: Neurology
Mistake in diagnosis
A dural arteriovenous fistula (DAVF), is an abnormal direct connection (fistula) between a meningeal artery and a meningeal vein or dural venous sinus. The pathogenesis of DAVF still remains unclear. Sinus thrombosis, head trauma, chronic central nervous system, hypercoagulable state, surgery, and hormonal influence are the pre-disposing factors that initiate this disease. The symptoms experienced by the patient will depend on the location of the fistula.
Case Report:
Thirty-two year old Hispanic male who presented one day after a rear ended motor vehicle collision (MVC) with a severe throbbing headache in the left parietal region, left eye redness but no retro-orbital pain and tinnitus in the left ear. He was initially misdiagnosed to have a carotid-cavernous fistula but upon cerebral angiogram was actually diagnosed with a dural arterio-venous fistula in the posterior fossa venous system followed by successful embolization of the fistula.
A cerebral angiography is the gold standard for detection and characterization of a DAVF and will distinguish it from a CCF. Endovascular surgery involves a catheter-based technique for embolization of the lumen of arteries feeding the DAVF, or directly into the vein draining the DAVF. It is very important to recognize the typical findings of patients presenting with a DAVF then quickly proceeding with a cerebral angiogram to determine the exact location of the fistula and the appropriate treatment plan. By diagnosing and treating a DAVF as early as possible, the associated fatal complications can be averted.
dural arteriovenous fistula; cerebral angiography; endovascular embolization; trauma
Related Articles
Localised invasive sino-orbital aspergillosis: characteristic features
Sivak-Callcott, J A
Livesley, N
Nugent, R A
Rasmussen, S L
Saeed, P
Rootman, J
The British Journal of Ophthalmology
Background/aim: To describe the characteristic constellation of historical, clinical, radiographic, and histopathological findings of localised invasive sino-orbital aspergillosis based on the authors' recent experience of four consecutive cases presenting over a 6 month period. Treatment and outcome are reviewed.
Methods: A case series of four patients with review of the English language literature.
Results: There have been 17 reported cases of invasive sino-orbital aspergillosis in healthy individuals over the past 33 years. The authors report four patients who presented during a 6 month period with persistent and significant pain followed by progressive ophthalmic signs—clinical histories reflecting the literature. Similar imaging findings were also noted: focal hypodense areas within apical infiltrates on contrasted computed tomography correspond to abscesses seen at surgery, and sinus obliteration or involvement of the adjacent sinus lining was noted on magnetic resonance imaging. Bone erosion (often focal) was also seen. There is frequently a delay in making the correct diagnosis, and often disease progression occurs despite treatment.
Conclusions: The authors encountered four cases of invasive sino-orbital aspergillosis, three of which occurred in otherwise healthy individuals. The clinician must be aware of the characteristic presentation so that earlier diagnosis, management, and improved outcomes can be achieved.
orbital aspergillosis; orbital infection
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Invasive aspergillosis in an immunocompetent patient with fever and a cardiac mass
LaBarbera, Matthew
Jacobson, Lester B.
Infectious Disease Reports
Invasive aspergillosis is an often fatal disease that usually occurs in immunocompromised patients. We report a case of invasive aspergillosis presenting as a febrile respiratory infection with a cardiac mass in an immunocompetent patient. Invasive asper-gillosis should be considered in the differential diagnosis of an otherwise undiagnosed invasive febrile respiratory illness, even in immunocompetent patients. Echocardiography should be performed to evaluate for endocarditis in such cases. Prompt initiation of appropriate antifungal therapy is warranted, even before the diagnosis of invasive aspergillosis is confirmed.
invasive aspergillosis; endocarditis; immunocompetent.
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Mucormycosis of the hard palate masquerading as carcinoma
Manjunatha, Bhari Sharanesha
Das, Nagarajappa
Sutariya, Rakesh V.
Ahmed, Tanveer
Clinics and Practice
A growing number of medically compromised patients are encountered by dentists in their practices. Opportunistic fungal infections such as mucormycosis usually occur in immunocompromised patients but can infect healthy individuals as well. Mucormycosis is an acute opportunistic, uncommon, frequently fatal fungal infection, caused by a saprophytic fungus that belongs to the class of phycomycetes. Among the clinical differential diagnosis we can consider squamous cell carcinoma. Such cases present as chronic ulcers with raised margins causing exposure of underlying bone. There is a close histopathological resemblance between mucormycosis and aspergillosis. Microscopically, aspergillosis has septate branching hyphae, which can be distinguished from mucormycotic hyphae by a smaller width and prominent acute angulations of branching hyphae. A definitive diagnosis of mucormycosis can be made by tissue biopsy that identifies the characteristic hyphae, by positive culture or both. The culture of diseased tissue may be negative and histopathologic examination is essential for early diagnosis. Mucormycosis was long regarded as a fatal infection with poor prognosis. However with early medical and surgical management survival rates are now thought to exceed 80%. In the present case, the fungus was identified by hematoxylin and eosin stain and confirmed by Grocott's silver methenamine special staining technique. Removal of the necrotic bone, which acted as a nidus of infection, was done. Post-operatively patient was advised an obturator to prevent oronasal regurgitation. Since mucormycosis occurs infrequently, it may pose a diagnostic and therapeutic dilemma for those who are not familiar with its clinical presentation.
fungal infection; mucormycosis; necrotic bone; phycomycetes; squamous cell carcinoma.
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Orbital apex syndrome due to aspergillosis with subsequent fatal subarachnoid hemorrhage
Yip, Chi-Man
Hsu, Shu-Shong
Liao, Wei-Chuan
Chen, Jun-Yih
Liu, Su-Hao
Chen, Chih-Hao
Surgical Neurology International
Orbital apex syndrome has been described previously as a syndrome involving damage to the oculomotor nerve (III), trochlear nerve (IV), abducens nerve (VI), and ophthalmic branch of the trigeminal nerve (V1), in association with optic nerve dysfunction. It may be caused by inflammatory, infectious, neoplastic, iatrogenic, or vascular processes.
Case Description:
A 73-year-old female having hypertension and rheumatoid arthritis stage 4 under long-term corticosteroid therapy presented to us with the right side orbital apex syndrome. Her magnetic resonance imaging (MRI) of orbit showed progression of a lesion at the right orbital apex and adjacent right superior orbital fissure with mild extension to the right posterior ethmoid sinus. She underwent endoscopic endonasal transethmoid approach with the removal of the lesion. The pathology showed a picture of fungal infection and the culture of the specimen proved Aspergillus fumigatus. Her postoperative course was smooth until 5 days after surgery, when she suffered a massive spontaneous subarachnoid hemorrhage resulting from a ruptured aneurysm, which was proven by computed tomography angiography (CTA) of brain. Unfortunately, she expired due to central failure.
In cases of immunocompromised patients having orbital apex syndrome, fungal infection should be kept in mind. One of the most lethal but rare sequels of CNS fungal infection is intracranial aneurysms. Early diagnosis and radical resection, combined with antifungal medications is the key to save this particular group of patients.
Aspergillosis; fungal aneurysm; orbital apex syndrome
Related Articles
Cerebral Air Embolism from Angioinvasive Cavitary Aspergillosis
Lin, Chen
Barrio, George A.
Hurwitz, Lynne M.
Kranz, Peter G.
Case Reports in Neurological Medicine
Background. Nontraumatic cerebral air embolism cases are rare. We report a case of an air embolism resulting in cerebral infarction related to angioinvasive cavitary aspergillosis. To our knowledge, there have been no previous reports associating these two conditions together. Case Presentation. A 32-year-old female was admitted for treatment of acute lymphoblastic leukemia (ALL). Her hospital course was complicated by pulmonary aspergillosis. On hospital day 55, she acutely developed severe global aphasia with right hemiplegia. A CT and CT-angiogram of her head and neck were obtained demonstrating intravascular air emboli within the left middle cerebral artery (MCA) branches. She was emergently taken for hyperbaric oxygen therapy (HBOT). Evaluation for origin of the air embolus revealed an air focus along the left lower pulmonary vein. Over the course of 48 hours, her symptoms significantly improved. Conclusion. This unique case details an immunocompromised patient with pulmonary aspergillosis cavitary lesions that invaded into a pulmonary vein and caused a cerebral air embolism. With cerebral air embolisms, the acute treatment option differs from the typical ischemic stroke pathway and the provider should consider emergent HBOT. This case highlights the importance of considering atypical causes of acute ischemic stroke.
Related Articles
A Case Of Invasive Aspergillosis in a Patient with No Identifiable Immunodeficiencies
Siddiqui, K
Douglas, M
Carey, MP
Benamer, HTS
The Libyan Journal of Medicine
Invasive fungal infections usually affect patients with immunodeficiencies and very rarely patients with no known or identifiable risk factors. Diagnosis could be delayed in patients without previously known immunodeficiencies due to a low index of suspicion, leading to a delay in treatment and a potential poor outcome. We report a case of a postpartum woman with no history of immuno-compromised disease who developed left hemiparesis with evidence of invasive aspergollosis affecting the nervous system, and leading to fatal outcome. The patient had a mass-like lesion in the neuroimaging with soft tissue shadowing in the chest x-ray leading to initial diagnosis of tuberculosis. The brain biopsy showed changes consistent with a diagnosis of aspergillosis. The source of the aspergillus infection was not clear. Aspergillus infection should be considered in patients with no identifiable immunodeficiencies who have abnormal brain imaging and chest x-ray, as early treatment may alter the outcome.
Related Articles
Combination therapy for chronic invasive rhinocerebral aspergillosis in a clinically immunocompetent patient
Lujber, László
Gerlinger, Imre
Kuncz, Ádám
Pytel, József
Current Therapeutic Research, Clinical and Experimental
Background: Adequate therapy for chronic invasive rhinocerebral aspergillosis in immunocompetent patients is controversial. The incidence of the disease is high in the Sudan and the Middle East. Misinterpretation of diagnostic criteria, failure to verify tissue invasion of fungi, and a lack of understanding of the pathophysiology of various forms of fungal rhinosinusitis lead to controversies in nomenclature, diagnosis, and therapy.
Objective: The aim of this report was to detail the clinical presentation and the endoscopic and imaging study findings of a patient with invasive Aspergillus rhinosinusitis with endocranial and orbital extension. This patient was treated with surgical débridement and a combination of antifungal drugs and immunomodulatory therapy.
Methods: Endoscopic débridement and high-dose liposomal amphotericin B, in combination with flucytosine and immunomodulators, were used to treat this patient.
Results: After treatment, the patient experienced 3 years of disease-free follow-up.
Conclusion: Surgical débridement and high-dose systemic combined antifungal therapy with immunomodulatory drugs produced an excellent long-term result for this apparently immunocompetent patient with extensive invasive fungal rhinosinusitis with cerebral and orbital involvement.
amphotericin B; aspergillosis; immunocompetent; invasive; rhinocerebral
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text: Boo Flag By: blackscales Channel: doctor-who (More by author: Most viewed, Newest, Most Thumbs) previous next random - Fav + Fav Comment Not sure if repost, but creepy as hell. Not mine. Glory to the internet. Recommend tagsx +452 Views: 27112 Favorited: 116 Submitted: 09/16/2012 Share On Facebook Remove from favorites Add to favorites Unsubscribe from blackscales Subscribe to blackscales Subscribe to doctor-who Unsubscribe from doctor-who

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Yamaha YCL-622II Low C Professional Bass Clarinet
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Professional bass clarinet with range to low C.
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Order when you are ready for a pro instrument. Now would be good.


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Dover Pro Shipping Boots help protect your horse's hocks, knees, fetlocks, pasterns, heels and coronary bands during travel. Ripstop lining helps repel shavings and dirt. Hard-wearing Cordura® nylon outer layer with foam middle layer to both comfort and protection. Set of 4.
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VRBO is part of the HomeAway family, the world leader in vacation rentals with over 1 million listings. We offer the largest selection of properties for any travel occasion and every budget. We're committed to helping families and friends find a perfect vacation rental to create unforgettable travel experiences together. Learn More
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The Redhawk Haven is a simple, Rustic Duplex Cabin backing to the San Juan National Forest. The Aspen unit is on the first floor with 2 bedrooms and 1 bath, two comfortable queen beds plus a daybed which can accommodate up to 6 people. It has a spacious open common area with and entertainment center including satellite TV, stereo and wifi. The kitchen is fully equipped with gadgets to satisfy chefs of most levels. There is a covered patio specifically for the first floor unit with spectacular views of the Mountains and Hatcher Lake. The back yard introduces a forest of immense beauty and scenery with and array of wildlife, untouched landscapes and a night sky filled with a galaxy of stars that will take your breath away.
If your idea of a prefect vacation is to become part of nature, observe its wonders and to see, hear and feel its beauty… then the Redhawk Haven is the place for you. We offer to people from all walks of life the opportunity to enjoy and explore the outdoors. Whether it be through rest and relaxation in a tranquil environment or experience new adventures through hiking, trekking, thermal springs, canoeing/kayaking, fishing, birding, horseback riding, photography, snowshoeing, skiing, sledding, stargazing, wildlife observation or sharing stories by the campfire…. its all just out the back door.
Located approximately 6 miles north of the small quaint mountain community of Pagosa Springs… Pagosah Indian word meaning "Healing Waters" they believe the rich hot spring minerals could heal anything and sure you will agree. Pagosa Springs is surrounded by the San Juan National Forest on 3 sides with the Ute Indian lands to the south leaving a playground of outdoor activities all around. Nearby attractions include Wolf Creek Ski resort (most recorded snowfall in Colorado), Chimney Rock (home to ancient Anasazi Ruins), the Old Mining town of Creede (famous Respitory Theater) and the beautiful Navajo Lake (for windsurfing, water ski and sail).
Visitors who have been here feel as if they have traveled back in time to a period where slow is good, stress, noise, pollution and crowds were non-existent and nature was unsurpassed, unspoiled and uncorrupted. The Redhawk Haven is an eco-conscious vacation rental fusing ecotourism, nature and adventure in an environmentally friendly manor…. leaving no trace behind. Whether you stay for a few nights, a week or longer we hope for people to leave nourished and reenergized by the silence and the experience of reconnecting to a land that seems a million miles away from the ordinary.
The closest airports are within... 60 miles from Durango, 200 from Albuquerque NM and 90 miles from Farmington NM.
*There is also an upper level Ponderosa studio unit #447140 that can accommodate up to 4 people
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The Redhawk Haven is conveniently located just 6 miles north of town. It backs to the San Juan National Forest and is just far away to to feel the serenity of the wilderness and still have access to the towns amenities such as public Hot Springs, stores, restaurants ect. If you enjoy outdoor adventures you can continue north from the cabin and explore Piedra falls, the Ice Caves and Williams Lake (great fishing spot). Whatever your agendas... you are far enough away from any touristy areas should you choose to avoid them.
Year Purchased: 2008
About the owner: Hello I am Rich Schlosser. I live in Phoenix Arizona and Pagosa Springs. It is the perfect balance for me because of my love for nature and the outdoors. I will do my best to make your visit the most memorable and help guide and assist you in as much adventure or solitude as you wish.
Why the Owner Chose Pagosa Springs:
I have skied the Rocky Mountains for many years. The winters are beautiful with ample activities but when I visited Pagosa for the first time in the summer of 2005 and experienced the colors, the textures, the wildlife and the outdoor adventures, I became hooked... I now come to Pagosa Springs once a month and spend the summers months here.
The Unique Benefits at this Cabin:
The Redhawk Haven is just 6 miles north of town and backs to the San Juan National forest which gives a serene feel of 'being away from it all'
Redhawk Haven Pagosa Springs CO
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Bedroom 1 (queen bed) with sumptuous linens
Bedroom 2 (daybed) pulls out to king or 2 twin
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fresh snow in front yard
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snowboarding Wolf Creek Ski resort
Pagosa Peaks winter scene
Aspen unit patio with lake and Mt views
San Juan National forest
Aspen unit fully equipped kitchen
Bedroom 2 (queen bed)
clean bathroom
full moon over Hatcher Lake
Kayaking Williams Lake
Redhawk Haven winter
winter views of Hatcher lake
Wolf Creek ski resort
Alberta Peak at Wolf Creek
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Town Square
Hatred of policemen made official in Oakland
Original post made by Naturalized Citizen, another community, on Mar 23, 2009
I was appalled when the official Master of ceremony made a negative comment about police in general when talking to newly sworn citizens. While explaining the process of applying for US passport and the need to submit the US citizenship certificate together with the application (which could make some people anxious because they won't have their greencard any more while waiting for the passport), he said: " If some nasty policeman stops you, you can tell him proudly "I am a US citizen now".
I felt very embarassed that a US official (a white male, by the way) would characterize a police officer as a "nasty", which creates a bad stigma and negative perception of police officers by newly made US citizens.
At the same meeting the chief editor of Oakland Tribune ( black male) who was a guest speaker at the ceremony commented negatively on US flag and said that prior to Barack Obama being elected president he couldn't "look at the flag" or something along those lines.
I am appalled that such comments were done by official people at the official ceremony where a thousand immigrants were naturalized.
And by irony Oakland's shooting of 4 police officers happens the same week.
The ceremony was videorecorded (if anyone wants the proof)
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text: Bubble Blowing Contest at Sparks in the Park 2014 Photos by Mimi Campbell at Townsquare Media (5) By Mimi C. July 7, 2014 5:25 PM Share on Facebook Share on Twitter Category: Share on Facebook Share on Twitter More Leave a comment Send to a friend! Print this page Pin it! Reddit This! Share on Tumblr! Best of Eagle 106.3 Sparks in The Park Cancelled Sparks in The Park Traffic Plan Why Americans Celebrate the 4th of July [VIDEO] Top 10 Patriotic Songs Recommended For You Best of the Web


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Above are photos taken last week while at the Abbey of Gethsemani. Since I began making an annual silent retreat in 1992 I've taken hundreds of photos. I always feel so blest by this opportunity. I'm always surprised in what God reveals here on this prayerfully hallowed ground that has been prayed on 7-times-a-day by the Trappist monks since 1848. My time is often marked by nameless healings and a profound sense of well-being. Perhaps taking pictures is a way to capture all of that or even an attempt to take it home with me.
Intellectually we all know that it isn't possible. We can't capture grace or healing or blessing. They're more elusive and more powerful than that. The Psalmist tells us: "God's mercies are new every morning." We know we needn't be afraid. And yet…
It's soulful work to trust God alone and to surrender our ideas, our plans, our will and our way, to His. When in the course of a day, a week, a lifetime my ego continues to set the agenda making sure I take care of myself or that I watch out for #1–my plans swirl like a springtime tornado sucking up whatever is in its way, leaving not much more than a splintered path in its wake. Hay, straw and stubble Scripture calls it. Then in enlightened moments (that may not last any longer than just a moment) we stand back and look at the debris field of our lives, wondering just how everything got so littered and twisted or in some cases, how so much went so very wrong.
Of course the image of a twister is dramatic. Perhaps in your life and mine there is instead just this dull angst. It's not that everything is wrong, but it's also not true that everything is right. We catch ourselves in unguarded moments taking in a deep telling sigh. Is this all there is, we wonder. Is this life I'm living really my purpose?
Deep silence only attainable in big chunks of time allows us to stop, to breathe, to fall backwards in a trust-fall into the arms of God. In deep silence we listen, rare, holy listening, without our agenda/phone/emails or instant messaging tangling Divine communication. Now after these 23 years, of my trek to this place with its silence, the moment I see the monastery wall as I approach from the winding road to the north, I experience a release of any anxiety or any other malady my body may be unconsciously holding. It's the feeling of coming home.
Do you have extended, intentional silent space in your life? Where and how do you listen for and receive God's mercies that are new to you every morning? How do you experience deep healing in your life? Or even how do you discern whether the path you're on is guided by the One who created you—who knit you together in your mother's womb? Are you travelling your path—or is that too scary a question to ask?
The momentum of our culture will carry us to places we were never intended to go if we let it. That's something to be mindful of for ourselves and with our children and grandchildren… We live in a time that too often rewards us for being someone we were never intended to be. Before we know it our life can be expended filling a particular hole that indeed needed filling—but was never ours to fill.
Let me encourage you to silence as you ponder these things. And allow me to offer you an exercise of Lectio Divina, without words. Use the photos I provided at the top, or Google search and download some beautiful images of your own. Then take the silent path with them for twenty minutes one morning and again that same evening. Let God alone speak as you look and listen without distraction. Allow Holy Spirit to touch any tightness or rough edges within. Then, rest for a while in Divine mercy, grace and love…allowing God do the healing work you need and that Christ made yours in the resurrection.
In the peace and joy of Eastertide,
Kathleen Bronagh Weller, firstname.lastname@example.com
P.S. If this exercise is meaningful to you, I would be pleased to hear from you. Thanks!


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The Big Sleep, Eastbourne
'This is the latest of three Big Sleep hotels to open in the UK,' explains Sian. 'The 50-bed Eastbourne hotel offers sea views from most of the spacious rooms. Fresh and funky interiors and one of the town's coolest bars and games rooms add to the attraction, as do reasonable rates that include a decent continental breakfast.'
Where King Edwards Parade, Eastbourne, BN21 4EB (01323 722676; www.thebigsleephotel.com)
How much doubles from £59, B&B
25th April 2014
We are pleased to be expanding on our breakfast selection which includes continental buffet items such as pastries & yogurts with added hot items bacon, sausage, hash browns & baked beans. Our new cooked items will be available from Monday 28th April 2014


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Voyces United For UNHCR is a benefit album. You'll have guessed that already from the title. It was released in Europe as a 2-CD set, and then in the U.S. as a single disc of fourteen tracks. I'm listening to the American version. The line-up features a bit of acoustic guitar, one unremarkable dance track, Mary Jane Lamond being swanlike and elegant in Gaelic, and several light pop songs of such brain-sucking vacuity that they drain the life out of everything around them like poisoned weeds in a garden. One singer tells me that she feels me inside her and another suggests that I follow my heart to find my dreams and I don't know who these people are and I don't dare to look up their names for fear that I will follow my heart to find them and then hit them, very hard, on the head, for while I am listening to Voyces United For UNHCR then visiting violence upon musicians such as this is indeed my dream. I am possessed of bloody urges, like Alicja Janosz in "Still Alive", who threatens to kill her ex-boyfriend because she was, like, sooooo nice to him and now he's dumped her, but she will survive, right? She's still alive! Take that, ex-boyfriend!
Colette Carr "Static" (video) (Premiere) // Music
House of Blondes "First of July" (audio) (premiere) // Music
Digisaurus 'No More Room For Love' (EP stream) // Music
Fave Five: Alpine
// Sound Affects
"Australian sextet Alpine's newest album is a fantastic expansion of their joyous pop sound, but two members give us five records apiece that helped define their unique musical identities.READ the article


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27 year old woman | Palos Hills, IL, USA | Seeking men 25-31 within 50 miles
Active within 5 days
My goal in life is to try everything once.
I'm not 100% sure about this online dating thing. However, it can be difficult to generate a relationship in conventional places, so why not try the unconventional? I am a family oriented person, being one of four girls (my poor father). I'm very motivated, looking to experience and see all that life has to offer. I am currently training for a half marathon and looking for a place where I can begin fencing lessons. I recently spent time in Europe, which has only enhanced my desire to travel. While I may want to try everything once, I also understand the importance of downtime. Sometimes, watching a movie or a football game on a couch can be the most rewarding thing in the world. I'm looking for someone who can make me laugh. I think friendship is the most important thing in a relationship. I'd like to have similar interests, but I'm always willing to learn/ like something new. I think it is extraordinarily difficult to pin down who you are and what you'd like in a partner. I believe that connections are made from getting to know someone and personalities meshing well.
Coffee and conversation , Dining out , Movies/Videos , Museums and art , Music and concerts , Exploring new areas , Travel/Sightseeing , Watching sports , Wine tasting
Bowling, Football, Running, Swimming, Walking / Hiking
I exercise 3-4 times per week.
Don't display my sign
I have Cats, Fish, Other
I like Birds, Dogs
Family, friends, food... and the Big Bang Theory
Being a teacher, I don't always have time for too many hobbies. But, when I am not grading papers, you can find me exploring the museums of Chicago, as well as seeing movies, reading, trying new sports, or grabbing a drink with friends.
The 100 Year Old Man who Climbed out the Window and Disappeared by Jonas Jonasson
Z{{Cta}} {{#if HasMoreInfo}} ?{{CtaSecondary}} {{/if}}
|What she is looking for
|5'2" (157cms)
|5'4" (162cms) to 6'3" (190cms)
|Body type:
|About average
|Slender, About average, Athletic and toned
|No preference
|No preference
|No Way
|No Way, Occasionally
|Social Drinker
|Social Drinker
|Education / Teacher / Professor
|No preference
|I'll tell you later
|$25,001 to $35,000, $35,001 to $50,000, $50,001 to $75,000, $75,001 to $100,000, $100,001 to $150,000, $150,001+
|Never Married
|Never Married
|Have kids:
|Wants kids:
|Definitely, Someday
|White / Caucasian
|White / Caucasian
|Christian / Catholic
|Christian / Catholic, Christian / LDS, Christian / Protestant, Christian / Other
|English, French
|Bachelors degree
|Associates degree, Bachelors degree, Graduate degree, PhD / Post Doctoral


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In lean times, the man girdle is born
It's for the man who has a little too much of everything - the man girdle, or "mirdle."
In a land where metrosexuals reign, a London department store is hoping to cash in on the lucrative men's underwear market Thursday by launching a throwback to the Victorian era, a gut-cinching garment that designers say will help men make it through these belt-tightening times.
The stretchy contraptions resemble normal sleeveless tank tops or long-sleeved T-shirts - only shrunk down two or three sizes in a special blend of Spandex, nylon and polyester. Control underwear will be launched later this…


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I'm in NJ and get my raw milk from PA. Feel free to PM me and I can give you the farm info - we've been drinking their milk for 8 years - never any issues. If you're too far from that farm, I can recommend a couple others. We are going to Colorado this summer and you can only get raw milk there if you own a cow share. So I will be bringing milk for DD frozen in Lansinoh breast milk bags. She's never had any pasteurized dairy and I don't want to give it to her on vacation either. We've flown with frozen breast milk twice and never had an issue. If neither option appeals to you, I'd recommend Natural by Nature milk, which you can get at health food stores. Their milk in glass bottles is pasteurized, but not homogenized. Their milk in cartons is pasteurized and homogenized (http://www.natural-by-nature.com/faq.htm). If you can't find that brand, I'd get Organic Valley. Don't buy Horizon - they are an aweful company.
I get whatever the best option available locally is, hopefully at least organic and non homogenized.
you have to watch- the health food stores near me (I am in PA) will not sell it in glass- I know of none and I am 45 mins from the dairy-cartons only - so you would need to check around if that is the one you want
Weis (chain grocery) is caring the Natural by Nature (with their name on it as well-store brand/N by N) full, and 2%- it's the homogenized but you might have more luck finding it-all over eastern PA-in paper cartons-in a pinch it is grass feed
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Freddie Jackson Events
|Winston Salem, NC
|Detroit, MI
|Detroit, MI
|Winston Salem, NC
|Top 5 matches
Events - There were 2 matches.
|The Whispers, Freddie Jackson & Dazz Band
|R&B / Soul
|Freddie Jackson
|R&B / Soul
Venues / Cities - There were 2 matches.
|Chene Park Amphitheater
|Detroit, MI
|RJ Reynolds Auditorium
|Winston Salem, NC
Venues / Cities - There were 2 matches.
|Chene Park Amphitheater
|Detroit, MI
|RJ Reynolds Auditorium
|Winston Salem, NC
|Top 5 matches
|Date & Location
|Freddie Jackson
|Wednesday, July 29, 2015 at 7:30 PM
Chene Park Amphitheater
|View Tickets
|The Whispers, Freddie Jackson & Dazz Band
|Saturday, September 26, 2015 at 8:00 PM
RJ Reynolds Auditorium
|View Tickets
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Eli Young Band Tickets
|Justin Bieber Tickets
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Tim McGraw Tickets
Love And Theft Tickets
|Your tickets will arrive before the event.
|Your tickets will be the ones you ordered, or better seats than you paid for.
|Our confidence in the sellers that list tickets on our exchange allows us to offer you this guarantee.


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41 year old woman | San Jose, CA, USA | Seeking men 34-45 within 50 miles
Looking for Athletic Geek
I'm looking for an athletic geek. Someone who can hold a conversation and enjoy the outdoors. I'm really into road cycling. I find that I'm spending most my weekends enjoying different areas of the bay area to cycle. During the weekdays, I'm physically preparing for the weekends. Heehee....Ultimately, I'm looking for someone who enjoys it as much as me. I'm not a pro, but an enthusiast. I'd love to travel to France and Italy and either take a bike tour or create our own. I think its important to have common goals and interests and cycling seems to be my passion. Just looking for someone kinda like me ;) My last trip, I went backpacking in the Grand Canyon at Havasupai. I'm looking to attract someone who is athletic and open to getting off the couch and enjoying the outdoors. I love hiking, cycling, camping, backpacking, seeing the world or everything in the bay area. I've lived in SJ most of my life along with a short 5 year stint in LA. Love both areas, but I have more family and friends in the bay area. Despite, the fact, that I have lived in the Bay Area most of my life, I am still discovering new areas. Gotta love it! I'd like to find someone with similar interests, attractive,funny, and can hold a conversation. So....To answer the questions and get it out of the way....no baggage for me. Never been married. No kids. (but I do have 2 nephews and 3 nieces). I come from a big family. I am the 3rd of 5. So I've been asked why I'm still single. Well....same ol story....boy finds girl....they date...they fall in love....it falls apart....and she does too....she doesn't want to go thru the "process" again....but she is now ready to do it once again. Hope to hear from you, otherwise, good luck on your search.
Camping , Coffee and conversation , Business networking , Dining out , Music and concerts , Exploring new areas , Wine tasting
Cycling, Golf, Other types of exercise, Running, Walking / Hiking, Weights / Machines, Yoga
I exercise 3-4 times per week.
I have Dogs
I have one dog, Boston Terrier.
Middle of the Road
Z{{Cta}} {{#if HasMoreInfo}} ?{{CtaSecondary}} {{/if}}
|What she is looking for
|5'1" (154cms)
|5'8" (172cms) to 6'5" (195cms)
|Body type:
|Athletic and toned
|Slender, About average, Athletic and toned
|Black, Blue, Brown, Grey, Green, Hazel
|Auburn / Red, Black, Light brown, Dark brown, Blonde, Salt and pepper, Dark blonde
|No Way
|No Way
|Social Drinker
|Social Drinker
|Other profession
|No preference
|I'll tell you later
|No preference
|Never Married
|No preference
|Have kids:
|Wants kids:
|I'll tell you later
|No preference
|No preference
|I'll tell you later
|No preference
|Bachelors degree
|Bachelors degree, Graduate degree, PhD / Post Doctoral


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SIEBEL PROJECT MANAGER Technical Summary Extensive Telecommunications experience including positions in: Business Environment Frankfurt, Vienna, Munich, New Zealand, and Singapore Extensive Banking / Insurance / Brokerage experience including positions in: Netherlands, Australia, London, Extensive Airlines / Airports experience including positions position: New Zealand, and Zagreb Areas of Expertise Project/Programme Management Management, CRM/E-CRM Greenfield, New Ventures E-commerce, M-commerce ( Portals Personalization, Ebanking/brokerage, Web-Mining ) Product Launch Management/Release Management Switches Implementation Data Warehouse Design, Implementation Systems Delivery Co-ordination, Systems Architecture Development Management & Co-ordination Packages/Systems Vantive Arbor OM/BP Comptel MDS/SAS/AMD Clarify, Siebel ICMS ICBS Case Tools Designer 2000 Oracle*Case IEF LMBS Databases Oracle V.6, V7.0.16, V7.1, V 7.2, V 7.3, V8.0,V8.1.6 Sybase,Supra, DB2 Employment History COMPANY INTERNATIONAL BANK, HOLLAND DATES: March 2000 – Present POSITION: Programme / Project Manager DESCRIPTION: Currently working for an E-Commerce team, set up as the new unit within the International Bank, functioning as the E-commerce centre of excellence and consulting department. Within the E-commerce team I am looking after a number of projects, in particular integration of E-technology with the existing infrastructure, e.g. international roll outs of multichannel and multi back end solutions, as well as consulting on CRM issues ( business requirements, systems specification etc etc ). My main area of expertise is integration of Internet tools ( Broadvision & Websphere ) with standard CRM channels. I have held a number of different roles: Joint Venture in France – Set up of new consumer savings and investment bank, Managed two sub-projects ; CRM and Call Center, as well as due diligence for the same areas, commercial agreements, vendor selection process, and lead in architecture design ( final solution based on SEMA – Broadvision and Siebel ). Call Center project included ACDs, CTI ( Genesys ), Centennium. A major project funded by European commission, focused on portal personalization, especially integration of data /web mining tools and customer profile information and Broadvision. Web Management – 10 million Euros annual budget, project manager, rolling out 100 web sites ( brochure and transactional ) internationally, mostly retail banking and Asset Management. ASP/JSP, Teamsite and Broadvision.. COMPANY I INTERNATIONAL TELECOMS COMPANY, GERMANY DATES: July 1999 – February 2000 POSITION: Programme Manager DESCRIPTION: Working for International Program Management and International Country support I was managing the implementation of new switch ( Nortel DMS100 recently installed in Vienna ) and duties included: Coordinating and managing implementation of all the releases required to support Voice and Data products & supporting E Commerce applications Negotiate contents of different releases, based on products availability and switch status Migration of customers from German switch to Vienna Switch Integration between billing and CRM (account management systems) (Siebel - Account management) Implementation of billing system ( Arbor BP ) and billing certification Resource planning, time management, budget management Coordinating work of other project managers ( e.g. process design team, training, new country set up ) Coordinating all the activities related to Alpha and Beta trials for voice and data products. System stack installed at the moment consists of Arbor/BP, TRAK, ICSB, Siebel, GPS, GOA. COMPANY: INTERNATIONAL TELECOMS COMPANY, GERMANY DATES: January 1998 – June 1999 POSITION: Release Management/Product Launch Management /Systems Integrator DESCRIPTION: While at this International Telecommunications Company, I focused on customer service provisioning and CRM, I spent a substantial amount of time on the integration of the multiple systems within the existing infrastructure. I performed the following tasks: Worked for Systems Architecture team and managed a team of 4 which worked on systems interfaces and systems integration. Team produced interfaces catalogue for 3 major product launches ( Covering Vantive, Arbor/OM, Arbor BP, Comptel MDS/SAS) As the member of Product Launch Management team monitored & coordinated delivery of core systems required for activation of mobile customer ( Vantive, Arbor/OM, Arbor/BP, Comptel MDS/SAS, Tuxedo Adapters ), e.g. monitored systems delivery across multiple projects & programmes. Responsible for implementation Interfaces between Vantive and Network Elements ( VMS, SMS, HLR etc ) for City Zone Worked for Systems Architecture team and managed a team of 4 which worked on systems interfaces and systems integration. Team produced interfaces catalogue for 3 major product launches ( Covering Vantive, Arbor/OM, Arbor BP, Comptel MDS/SAS) Release Manager role for Point of Sales System Worked on Y2000 project as IM Contingency Plan & Business continuity coordinator & Project analyst for 7 applications ( Data Warehouse, Correspondence and Imaging system, Number Porting etc..) Designed and assisted with implementation o Print Shop interface between Arbor BP and Print Shop COMPANY: CONSOLIDATED FINANCIAL INSURANCE COMPANY, London DATES: July 1997 –December 1997 POSITION: Data Warehouse Architect ENVIRONMENT: Oracle V.7.3, Developer/Designer2000 DESCRIPTION: Worked closely with business on definition on data warehouse business requirements Coordinated work on datawarehouse design and implementation Produced corporate data warehouse logical data model Produced physical database design for data warehouse. Designed and implemented relational database and star schemes required to support two tier data warehouse. Prepared and conduced 3 days course about Designer 2000 and concepts of logical and physical database design Coordinated work on logical data model & database design for major Insurance systems Used Designer 2000 to document work on data models, and data warehouse data loads Performed some of development DBA duties regarding the set up and implementation of data warehouse design Performed general consulting regarding Oracle RDBMS, data warehouse concepts and data modelling concepts Assisted in creation of logical data models for Warranties and Creditors operational systems. COMPANY: STRATEGIC CONSULTANCY SERVICES COMPANY DATES: February 1997- July 1997 POSITION: Senior Consultant ENVIRONMENT: Oracle V.7.3, Discoverer 3.0, Developer/Designer2000 DESCRIPTION: Coordinated work with business users from all departments regarding the data warehouse requirement for Churn Management and Target marketing Managed development of two front end applications - Churn Management ( Developer 2000) and Target Marketing ( Discoverer 3.0) - team of 9 developers Worked on data warehouse project for Airline Company in Singapore. Warehouse covered all the business area relevant for Airline Company ( paging, mobile services, Internet services, long distance calls, business communications, etc) I was involved in definition of user requirements and worked on technical architecture, dimensions and hierarchies design for 4 main subject areas. Designed and developed Churn Management Prototype COMPANY: INTERNATIONAL BANK, AUSTRALIA DATES: August 1996 to February 1997 POSITION: Senior Architect ENVIRONMENT: Oracle V.7.2 DESCRIPTION: Direct banking - business requirements and logical data model for marketing, campaign management and customer contact log. Performance and Planning System - technical consulting, assisted with system architecture design. Designed reporting interface system Direct banking - business requirements and logical data model for marketing, campaign management and customer contact log. General consulting for Oracle based systems within the CBA Technical support for Oracle based systems within the CBA. COMPANY: INTERNATIONAL TELECOMS COMPANY, NEW ZEALAND DATES: June 1994 to July 1996 POSITION: Consultant ENVIRONMENT: Operating system AIX Software SQL*PLUS PL/SQL 2.0 SQL*Loader SQL*Reportwriter 2.0 Developer 2000 - Reportwriter 2.5 Database Oracle V.7.0 , 7.1,7.2 Other Designer 2000 Oracle Case 5.0 DESCRIPTION: MARCH 1995 - NOVEMBER 1996 CUSTOMER SALES AND SERVICE PROJECT Performed Development Manager/Project Manager role and coordinated work of 6 - 8 developers on campaign development project. Team Leader for pilot project with Designer 2000, working with Oracle representatives, applying CDM methodology on process design, logical & physical design and application generation. As the senior member of the Architecture team I coordinated change control, implemented changes in Case 5.0, Designer 2000 and Oracle 7.1&7.2 Produced business requirements for interfaces with ICMS billing system Worked on process design for overall customers sales and services system. Involved in Marketing Data Warehouse design Produced business requirements, for Account Management System Coordinating migration of data and code changes between all the environments JUNE 1994 - MARCH 1995 NFWMS PROJECT I was involved in the National Fault and Work Management Project. Initially assisted DBAs with data integrity problems and their correction. While I did not perform the duties of a DBA on the production system, I did perform development DBA duties. Coordination and management of PL/SQL developers Development DBA Design and implementation of Service window application Design, plan and implement the conversion and upload of historic data from Foxpro to Oracle - SQL*Loader and P/L SQL Designed and implemented download procedure from NFWMS to Planning and Analysis system Involvement with "Reporting" group with NFWMS project Involvement in the business specification and implementation of NFWMS reports - all reports written in SQL*Reportwriter 2.0 Rewrote some UNIFACE procedures - PL/SQL 2.0 (achieved reduction in processing time for some transactions from 13 to 3 seconds) COMPANY: INTERNATIONAL PETROLEUM COMPANY DATES: July - August 1995 POSITION: Data Base Designer ENVIRONMENT Operating system Unix Software LBMS, Access Database Sybase DESCRIPTION: I was responsible for database design for the Best Practices warehouse. I produced and documented logical/physical data model and generated database in Sybase. COMPANY: INTERNATIONAL AIRLINE COMPANY, NEW ZEALAND DATES: October 1992 to May 1994 POSITION: Project Manager ENVIRONMENT: Operating system Unix Software SQL GUPTA SQLWindows PL/SQL Database DB2, Oracle V.6.0 and V.7.0 Other MS Project, IEF DESCRIPTION: My primary function was to manage the implementation of their Medium Term Planning system. The system was a client server system with front end programs written in GUPTA SQL Windows with Oracle database running on SUN. Some of my main activities included: Development DBA duties for MTP Designed and implemented QMF procedures on the mainframe and downloaded procedures from DB2 to Oracle Spent considerable time improving performance efficiencies of PL/SQL programs, achieving runtime reductions from 1 hour to 2 minutes data modeling using IEF case tool Initiated work on programming standards for client server applications Involved closely with Oracle conversion from V 6.0 to V7.0 Project Management duties including - planning, resource management, budgeting , etc. Prepared basic UNIX course for the Marketing project team Maintained and developed Gupta and PL/SQL programs. COMPANY: NATIONAL DAIRY PRODUCE ORGANISATION – NEW ZEALAND PERIOD: May 1990 to August 1992 POSITION: Analyst Programmer/Analyst/Senior Analyst ENVIRONMENT: Operating system MVS/VS Software SQL MANTIS COBOL EASYTREV Database SUPRA 2.1 RESPONSIBILITIES: I was involved in a number of projects. Some of my activities included: Systems analysis and design Programming, documentation and enhancements to existing software Staff assistance and training Developed a terminal Inventory management system - SQL and MANTIS. COMPANY: INTERNATIONAL LIFE ASSURANCE COMPANY PERIOD: March 1990 to May 1990 POSITION: Analyst Programmer ENVIRONMENT: Operating system DOS Software COBOL RESPONSIBILITIES: I worked within the Branch Management System Team. I lead a team of 4 developing an extensive system to support the Sales Agents. I was in the development of programs for general insurance and a Special Scheme System. COMPANY: INTERNATIONAL AIRPORT, ZAGREB PERIOD: May 1987 to January 1990 POSITION: Project Leader ENVIRONMEN: Operating system IMOS, MS DOS Software C COBOL RESPONSIBILITIES: This is the largest airport in Croatia with over 700 staff. I was responsible for the development and implementation of the Financial, Personnel and Payroll systems and leading a team of 3. The development involved extensive user liaison. COMPANY: GOVERNMENT DEPARTMENT – CROATIA PERIOD: March 1984 to May 1987 POSITION: Systems Analyst ENVIRONMENT: Operating system MVS/VS Software COBOL PLI Database IMS/DLI RESPONSIBILITIES: The Department administered all Social Insurance and compulsory pension contributions for Croatia. I worked as part of a team of 3 analysts with a project leader. We were involved in database design. We were involved in the design and implementation of Financial accounting and Insurance Information systems. I contributed to writing the internal and external system design of the insurance system as well as writing user manuals. Education History 1983 - 1999 Various courses covering data analysis, database administration, etc, information available on request. 1978 to 1982 Masters Equivalent – Information Systems Technology
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A resource for journalists who cover violence
While emergency workers have, particularly in the last decade, recognized the need for self-care and organizational duty of care, journalists may not yet have been recognized as potential candidates for employee safeguards and increased support. Journalists need to remember that there may be a number of potential stress reactions they may have when they report on particularly stressful topics, and know the strategies and resources they can use to stay resilient.
An overview of current research on the occupational hazards for journalists covering traumatic events, the risk factors that aggravate those effects and some suggestions for mitigating those factors.
Over the last three weeks, a pair of powerful earthquakes shook Nepal, resulting in the deaths of more than 8,000 people. The Dart Center spoke with journalists Russell Lewis and Amantha Perera, and clinician Patrice Keats, about the challenges of covering this tragedy, including verifying information in a time of emergency, speaking with families of missing people, and working through the personal challenges of covering trauma.
Psychologist Anthony Feinstein examines a confluence of factors that can undermine the emotional well-being of journalists, including the emergence of new threats in Syria, the relentless nature of the conflict and those predominantly tasked with covering it. This piece was originally published in The Globe and Mail.
A Taliban attack on a school in Peshawar, Pakistan, left 145 people dead, more than 100 of them children. Among the dead were nine Taliban gunmen, according to the army press office.
Christoph Bangert and Alan Chin have photographed gruesome scenes around the world and argued with editors about why they are important for the public to see. Earlier this year, Bangert published a new book, "War Porn," in which he confronts the arguments and ethics over violent imagery in new ways. In a Dart Center exclusive, the two photographers sat down to discuss their work, its origins and impact.
Editor and Publisher
Joe Strupp and Doug Cosper discuss the problems faced by journalists in extreme situations, with emphasis on the challenges faced at the World Trade Center after 9/11.
This documentary, available online and on DVD, features a wide range of Australian journalists their recounting experiences covering traumatic stories.
This documentary, available online and on DVD, examines the impact of the news coverage of the Columbine High School shootings.
Your contributions help the Dart Center nurture informed, innovative and ethical news reporting on violence, conflict and tragedy worldwide.
The Dart Center is a project of the Columbia University Graduate School of Journalism.
© Trustees of Columbia University in the City of New York