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1.
Microorganisms ; 9(9)2021 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-34576892

RESUMO

Treatment of Shiga toxin-producing Escherichia coli O157 (O157) diarrhea with antimicrobials might alter the risk of hemolytic uremic syndrome (HUS). However, full characterization of which antimicrobials might affect risk is lacking, particularly among adults. To inform clinical management, we conducted a case-control study of residents of the FoodNet surveillance areas with O157 diarrhea during a 4-year period to assess antimicrobial class-specific associations with HUS among persons with O157 diarrhea. We collected data from medical records and patient interviews. We measured associations between treatment with agents in specific antimicrobial classes during the first week of diarrhea and development of HUS, adjusting for age and illness severity. We enrolled 1308 patients; 102 (7.8%) developed confirmed HUS. Antimicrobial treatment varied by age: <5 years (12.6%), 5-14 (11.5%), 15-39 (45.4%), ≥40 (53.4%). Persons treated with a ß-lactam had higher odds of developing HUS (OR 2.80, CI 1.14-6.89). None of the few persons treated with a macrolide developed HUS, but the protective association was not statistically significant. Exposure to "any antimicrobial" was not associated with increased odds of HUS. Our findings confirm the risk of ß-lactams among children with O157 diarrhea and extends it to adults. We observed a high frequency of inappropriate antimicrobial treatment among adults. Our data suggest that antimicrobial classes differ in the magnitude of risk for persons with O157 diarrhea.

2.
MMWR Morb Mortal Wkly Rep ; 70(38): 1332-1336, 2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34555002

RESUMO

Foodborne illnesses are a substantial and largely preventable public health problem; before 2020 the incidence of most infections transmitted commonly through food had not declined for many years. To evaluate progress toward prevention of foodborne illnesses in the United States, the Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program monitors the incidence of laboratory-diagnosed infections caused by eight pathogens transmitted commonly through food reported by 10 U.S. sites.* FoodNet is a collaboration among CDC, 10 state health departments, the U.S. Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration. This report summarizes preliminary 2020 data and describes changes in incidence with those during 2017-2019. During 2020, observed incidences of infections caused by enteric pathogens decreased 26% compared with 2017-2019; infections associated with international travel decreased markedly. The extent to which these reductions reflect actual decreases in illness or decreases in case detection is unknown. On March 13, 2020, the United States declared a national emergency in response to the COVID-19 pandemic. After the declaration, state and local officials implemented stay-at-home orders, restaurant closures, school and child care center closures, and other public health interventions to slow the spread of SARS-CoV-2, the virus that causes COVID-19 (1). Federal travel restrictions were declared (1). These widespread interventions as well as other changes to daily life and hygiene behaviors, including increased handwashing, have likely changed exposures to foodborne pathogens. Other factors, such as changes in health care delivery, health care-seeking behaviors, and laboratory testing practices, might have decreased the detection of enteric infections. As the pandemic continues, surveillance of illness combined with data from other sources might help to elucidate the factors that led to the large changes in 2020; this understanding could lead to improved strategies to prevent illness. To reduce the incidence of these infections concerted efforts are needed, from farm to processing plant to restaurants and homes. Consumers can reduce their risk of foodborne illness by following safe food-handling and preparation recommendations.


Assuntos
COVID-19/epidemiologia , Microbiologia de Alimentos/estatística & dados numéricos , Parasitologia de Alimentos/estatística & dados numéricos , Doenças Transmitidas por Alimentos/epidemiologia , Pandemias , Conduta Expectante , Adolescente , Criança , Pré-Escolar , Doenças Transmitidas por Alimentos/microbiologia , Doenças Transmitidas por Alimentos/parasitologia , Humanos , Incidência , Lactente , Estados Unidos/epidemiologia
3.
J Forensic Sci ; 66(6): 2283-2288, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34363394

RESUMO

New Mexico's oil and natural gas industry has the second highest occupational fatality rate among oil and gas workers in the nation. There is currently limited data available regarding the top contributing factors to occupational mortality specific to the state's oil and gas industry. This study seeks to understand causes of mortality among oil and gas workers in New Mexico between 2008 and 2018. To facilitate this study, case reports were obtained from the New Mexico Office of the Medical Investigator, and population data was acquired from the US Department of Labor. In this 11-year span, there were 73 cases, with an average annual mortality rate of 37 deaths per 100,000 oil and gas workers. Leading causes of death were vehicle accidents (36%), cardiovascular incidents (22%), and crush injuries (19%). The majority of vehicle accidents involved single vehicle accidents, and correct seat belt use was only documented 23% of the time. The majority of cardiovascular deaths were due to arteriosclerotic and atherosclerotic cardiovascular disease. Alcohol was present in 18% of cases, and drugs were present in 19% of cases with methamphetamine present in 10% of investigated deaths. This is the first study to directly include cardiovascular incidents in the leading causes of death; otherwise, this study reflects national data reporting vehicle accidents and crush injuries as the leading causes of death. Going forward, prevention measures should effectively target safe driving practices focusing on seatbelt use, and mitigation of workplace drug and alcohol consumption.


Assuntos
Acidentes de Trabalho/mortalidade , Doenças Cardiovasculares/mortalidade , Indústria de Petróleo e Gás , Ferimentos e Lesões/mortalidade , Adolescente , Adulto , Idoso , Concentração Alcoólica no Sangue , Serviços Médicos de Emergência/estatística & dados numéricos , Humanos , Drogas Ilícitas/análise , Masculino , Pessoa de Meia-Idade , New Mexico/epidemiologia , Estações do Ano , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
4.
Am J Forensic Med Pathol ; 42(3): 243-247, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-33833195

RESUMO

ABSTRACT: The border wall between the United States and Mexico consists of stretches of metal fencing of varying heights alternating and overlapping with areas of electronic surveillance. Despite national conversations centered around the social, environmental, economic, and political implications of this wall, there is a paucity of studies on deaths occurring in this region. Herein are described 2 cases of fatal injuries sustained from scaling the fence and accidentally falling onto the United States' side in New Mexico. These injuries are compared with those typically incurred in falls from lower and higher heights, and implications of both lateral and vertical expansion of the wall are discussed.


Assuntos
Acidentes por Quedas , Emigração e Imigração , Ferimentos não Penetrantes/patologia , Adulto , Feminino , Fraturas Múltiplas/diagnóstico por imagem , Hemotórax/diagnóstico por imagem , Humanos , Masculino , Enfisema Mediastínico/diagnóstico por imagem , México , Pessoa de Meia-Idade , Pneumotórax/diagnóstico por imagem , Enfisema Subcutâneo/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Estados Unidos
5.
Am J Forensic Med Pathol ; 42(1): 1-8, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33416234

RESUMO

ABSTRACT: The 2019 novel coronavirus disease (COVID-19) has spread worldwide, infiltrating, infecting, and devastating communities in all locations of varying demographics. An overwhelming majority of published literature on the pathologic findings associated with COVID-19 is either from living clinical cohorts or from autopsy findings of those who died in a medical care setting, which can confound pure disease pathology. A relatively low initial infection rate paired with a high biosafety level enabled the New Mexico Office of the Medical Investigator to conduct full autopsy examinations on suspected COVID-19-related deaths. Full autopsy examination on the first 20 severe acute respiratory syndrome coronavirus 2-positive decedents revealed that some extent of diffuse alveolar damage in every death due to COVID-19 played some role. The average decedent was middle-aged, male, American Indian, and overweight with comorbidities that included diabetes, ethanolism, and atherosclerotic and/or hypertensive cardiovascular disease. Macroscopic thrombotic events were seen in 35% of cases consisting of pulmonary thromboemboli and coronary artery thrombi. In 2 cases, severe bacterial coinfections were seen in the lungs. Those determined to die with but not of severe acute respiratory syndrome coronavirus 2 infection had unremarkable lung findings.


Assuntos
COVID-19/mortalidade , Pulmão/patologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Autopsia , Índice de Massa Corporal , Edema Encefálico/patologia , Cardiomegalia/patologia , Comorbidade , Trombose Coronária/patologia , Bases de Dados Factuais , Fígado Gorduroso/patologia , Feminino , Patologia Legal , Glomerulosclerose Segmentar e Focal/patologia , Hepatomegalia/patologia , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Nefroesclerose/patologia , New Mexico/epidemiologia , Sobrepeso/epidemiologia , Pandemias , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/patologia , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/patologia , Distribuição por Sexo , Streptococcus pneumoniae/isolamento & purificação , Tomografia Computadorizada por Raios X , Corpo Vítreo/química , Imagem Corporal Total
6.
Drug Alcohol Depend ; 215: 108175, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32871508

RESUMO

BACKGROUND: Excessive alcohol use is an important component of a person's risk for drug overdose death. But alcohol's contribution to overdose death risk has not been well quantified. We aimed to quantify the role of excessive alcohol use, particularly as defined by a blood alcohol concentration (BAC) ≥0.08 g/dL, in drug overdose deaths in New Mexico (NM). METHODS: The study was conducted in 2018. We abstracted death records (scene investigation, toxicology, pathology) for all drug overdose deaths in NM during 2015-2016, information on BAC, other indications of alcohol, risk factors, comorbidities, and drug type and linked this information with demographic characteristics on death certificates. A Poisson regression model was used to determine independent associations between decedents' characteristics and alcohol involvement among drug overdose decedents. RESULTS: Approximately 18 % (n = 170) of the 946 drug overdose decedents in this study had a BAC ≥ 0.08 g/dL. After adjustment, drug overdose decedents who were American Indian/Alaska Native or had a history of alcohol use disorder were more likely to have had a BAC ≥ 0.08 g/dL at the time of death. However, decedents who had methamphetamine involved in their death or who had a history of diabetes, mental illness, or chronic pain were less likely to have a BAC ≥ 0.08 g/dL at the time of death. CONCLUSIONS: Nearly 1 in 5 overdose decedents had a BAC ≥ 0.08 g/dL at the time of death, suggesting that evidence-based alcohol prevention strategies (e.g., increasing alcohol taxes, regulating alcohol outlet density) could reduce the risk of drug overdose death.


Assuntos
Alcoolismo/epidemiologia , Overdose de Drogas/epidemiologia , Adulto , Concentração Alcoólica no Sangue , Etanol/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New Mexico/epidemiologia , Fatores de Risco
7.
MMWR Morb Mortal Wkly Rep ; 69(17): 509-514, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32352955

RESUMO

To evaluate progress toward prevention of enteric illnesses, the Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program monitors the incidence of laboratory-diagnosed infections caused by eight pathogens transmitted commonly through food at 10 U.S. sites.* This report summarizes preliminary 2019 data and describes changes in incidence compared with that during 2016-2018. The incidence of enteric infections caused by these eight pathogens reported by FoodNet sites in 2019 continued to increase or remained unchanged, indicating progress in controlling major foodborne pathogens in the United States has stalled. Campylobacter and Salmonella caused the largest proportion of illnesses; trends in incidence varied by Salmonella serotype. Widespread adoption of whole genome sequencing (WGS) of bacteria has improved the ability to identify outbreaks, emerging strains, and sources of pathogens. To maximize the potential of WGS to link illnesses to particular sources, testing of isolates by clinical and public health laboratories is needed. Reductions in Salmonella serotype Typhimurium suggest that targeted interventions (e.g., vaccinating chickens and other food animals) might decrease human infections. Reducing contamination during food production, processing, and preparation will require more widespread implementation of known prevention measures and of new strategies that target particular pathogens and serotypes.


Assuntos
Doenças Transmitidas por Alimentos/epidemiologia , Vigilância da População , Microbiologia de Alimentos , Parasitologia de Alimentos , Doenças Transmitidas por Alimentos/microbiologia , Doenças Transmitidas por Alimentos/parasitologia , Humanos , Incidência , Estados Unidos/epidemiologia
8.
J Infect Dis ; 222(8): 1405-1412, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-31758182

RESUMO

BACKGROUND: The relationships between socioeconomic status and domestically acquired salmonellosis and leading Salmonella serotypes are poorly understood. METHODS: We analyzed surveillance data from laboratory-confirmed cases of salmonellosis from 2010-2016 for all 10 Foodborne Disease Active Surveillance Network (FoodNet) sites, having a catchment population of 47.9 million. Case residential data were geocoded, linked to census tract poverty level, and then categorized into 4 groups according to census tract poverty level. After excluding those reporting international travel before illness onset, age-specific and age-adjusted salmonellosis incidence rates were calculated for each census tract poverty level, overall and for each of the 10 leading serotypes. RESULTS: Of 52 821geocodable Salmonella infections (>96%), 48 111 (91.1%) were domestically acquired. Higher age-adjusted incidence occurred with higher census tract poverty level (P < .001; relative risk for highest [≥20%] vs lowest [<5%] census tract poverty level, 1.37). Children <5 years old had the highest relative risk (2.07). Although this relationship was consistent by race/ethnicity and by serotype, it was not present in 5 FoodNet sites or among those aged 18-49 years. CONCLUSION: Children and older adults living in higher-poverty census tracts have had a higher incidence of domestically acquired salmonellosis. There is a need to understand socioeconomic status differences for risk factors for domestically acquired salmonellosis by age group and FoodNet site to help focus prevention efforts.


Assuntos
Redes Comunitárias/estatística & dados numéricos , Doenças Transmitidas por Alimentos/epidemiologia , Pobreza/estatística & dados numéricos , Infecções por Salmonella/epidemiologia , Censos , Redes Comunitárias/organização & administração , Doenças Transmitidas por Alimentos/microbiologia , Humanos , Incidência , Vigilância da População , Fatores de Risco , Salmonella/classificação , Salmonella/isolamento & purificação , Infecções por Salmonella/microbiologia , Sorogrupo , Estados Unidos/epidemiologia
9.
MMWR Morb Mortal Wkly Rep ; 68(16): 369-373, 2019 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-31022166

RESUMO

Foodborne diseases represent a major health problem in the United States. The Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program monitors cases of laboratory-diagnosed infection caused by eight pathogens transmitted commonly through food in 10 U.S. sites.* This report summarizes preliminary 2018 data and changes since 2015. During 2018, FoodNet identified 25,606 infections, 5,893 hospitalizations, and 120 deaths. The incidence of most infections is increasing, including those caused by Campylobacter and Salmonella, which might be partially attributable to the increased use of culture-independent diagnostic tests (CIDTs). The incidence of Cyclospora infections increased markedly compared with 2015-2017, in part related to large outbreaks associated with produce (1). More targeted prevention measures are needed on produce farms, food animal farms, and in meat and poultry processing establishments to make food safer and decrease human illness.


Assuntos
Surtos de Doenças , Microbiologia de Alimentos/estatística & dados numéricos , Parasitologia de Alimentos/estatística & dados numéricos , Doenças Transmitidas por Alimentos/epidemiologia , Vigilância em Saúde Pública , Testes Diagnósticos de Rotina/estatística & dados numéricos , Humanos , Incidência , Estados Unidos/epidemiologia
10.
Artigo em Inglês | MEDLINE | ID: mdl-29930915

RESUMO

Sin Nombre virus (SNV) causes hantavirus cardiopulmonary pulmonary syndrome (HCPS) with the loss of pulmonary vascular endothelial integrity, and pulmonary edema without causing cytopathic effects on the vascular endothelium. HCPS is associated primarily with a dysregulated immune response. We previously found occult signs of hemostatic imbalance in the form of a sharp >30-100 fold increase in the expression of plasminogen activator inhibitor type 1 (PAI-1), in serial blood plasma draws of terminal stage-patients. However, the mechanism of the increase in PAI-1 remains unclear. PAI-1 is a primary inhibitor of fibrinolysis caused by tissue plasminogen activator (tPA) and urokinase plasminogen activator plasma (uPA). Here, we investigate factors that contribute to PAI-1 upregulation during HCPS. Using zymography, we found evidence of PAI-1-refractory uPA activity and no tPA activity in plasma samples drawn from HCPS patients. The sole prevalence of uPA activity suggested that severe inflammation drove PAI-1 activity. We have recently reported that the P2Y2 receptor (P2Y2R) mediates SNV infectivity by interacting in cis with ß3 integrins, which activates the latter during infection. P2Y2R is a known effector for several biological processes relevant to HCPS pathogenesis, such as upregulation of tissue factor (TF), a primary initiator of the coagulation cascade, stimulating vascular permeability and leukocyte homing to sites of infection. As P2Y2R is prone to upregulation under conditions of inflammation, we compared the expression level of P2Y2R in formalin fixed tissues of HCPS decedents using a TaqMan assay and immunohistochemistry. Our TaqMan results show that the expression of P2Y2R is upregulated significantly in HCPS cases compared to non- HCPS controls (P < 0.001). Immunohistochemistry showed that lung macrophages were the primary reservoir of high and coincident localization of P2Y2R, uPA, PAI-1, and TF antigens. We also observed increased staining for SNV antigens in the same tissue segments where P2Y2R expression was upregulated. Conversely, sections of low P2Y2R expression showed weak manifestations of macrophages, SNV, PAI-1, and TF. Coincident localization of P2Y2R and PAI-1 on macrophage deposits suggests an inflammation-dependent mechanism of increasing pro-coagulant activity in HCPS in the absence of tissue injury.


Assuntos
Infecções por Hantavirus , Hantavirus/patogenicidade , Inibidor 1 de Ativador de Plasminogênio/metabolismo , Receptores Purinérgicos P2Y2/metabolismo , Regulação para Cima , Ativador de Plasminogênio Tipo Uroquinase/metabolismo , Adulto , Idoso , Permeabilidade Capilar , Feminino , Fibrinólise , Infecções por Hantavirus/diagnóstico por imagem , Infecções por Hantavirus/imunologia , Infecções por Hantavirus/patologia , Síndrome Pulmonar por Hantavirus/diagnóstico por imagem , Síndrome Pulmonar por Hantavirus/imunologia , Síndrome Pulmonar por Hantavirus/patologia , Humanos , Imuno-Histoquímica , Inflamação , Leucócitos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , New Mexico , Transdução de Sinais , Ativador de Plasminogênio Tecidual , Ativador de Plasminogênio Tipo Uroquinase/sangue
11.
MMWR Morb Mortal Wkly Rep ; 67(11): 324-328, 2018 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-29565841

RESUMO

Despite ongoing food safety measures in the United States, foodborne illness continues to be a substantial health burden. The 10 U.S. sites of the Foodborne Diseases Active Surveillance Network (FoodNet)* monitor cases of laboratory-diagnosed infections caused by nine pathogens transmitted commonly through food. This report summarizes preliminary 2017 data and describes changes in incidence since 2006. In 2017, FoodNet reported 24,484 infections, 5,677 hospitalizations, and 122 deaths. Compared with 2014-2016, the 2017 incidence of infections with Campylobacter, Listeria, non-O157 Shiga toxin-producing Escherichia coli (STEC), Yersinia, Vibrio, and Cyclospora increased. The increased incidences of pathogens for which testing was previously limited might have resulted from the increased use and sensitivity of culture-independent diagnostic tests (CIDTs), which can improve incidence estimates (1). Compared with 2006-2008, the 2017 incidence of infections with Salmonella serotypes Typhimurium and Heidelberg decreased, and the incidence of serotypes Javiana, Infantis, and Thompson increased. New regulatory requirements that include enhanced testing of poultry products for Salmonella† might have contributed to the decreases. The incidence of STEC O157 infections during 2017 also decreased compared with 2006-2008, which parallels reductions in isolations from ground beef.§ The declines in two Salmonella serotypes and STEC O157 infections provide supportive evidence that targeted control measures are effective. The marked increases in infections caused by some Salmonella serotypes provide an opportunity to investigate food and nonfood sources of infection and to design specific interventions.


Assuntos
Microbiologia de Alimentos , Parasitologia de Alimentos , Doenças Transmitidas por Alimentos/epidemiologia , Vigilância da População , Doenças Transmitidas por Alimentos/microbiologia , Doenças Transmitidas por Alimentos/parasitologia , Humanos , Incidência , Estados Unidos/epidemiologia
12.
J Forensic Sci ; 63(5): 1401-1405, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29464693

RESUMO

We explored the value of postmortem computed tomography (PMCT) to augment autopsy in evaluating strangulation fatalities. A literature search identified 16 studies describing autopsy findings in 576 deaths and two studies describing autopsy and PMCT findings in six deaths. Similar cases were identified from our institution, yielding 130 deaths with autopsy findings and 14 deaths with both autopsy and PMCT findings. The presence of laryngohyoid fracture and soft tissue hemorrhage was compared from autopsy and autopsy+PMCT cases. The detection rates of fractures in autopsy and autopsy+PMCT cases were not significantly different. PMCT identified all fractures observed at autopsy and five fractures not identified. While PMCT may not detect soft tissue injuries in decomposed remains or subtle internal hemorrhages in neck injury, it is equally able to detect bony injuries as autopsy and might surpass autopsy in detecting subtle fractures. We conclude PMCT is useful to supplement autopsy in strangulation cases.


Assuntos
Asfixia/diagnóstico por imagem , Lesões do Pescoço/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Autopsia/métodos , Criança , Pré-Escolar , Cartilagem Cricoide/diagnóstico por imagem , Cartilagem Cricoide/lesões , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas de Cartilagem/diagnóstico por imagem , Hemorragia/diagnóstico por imagem , Humanos , Osso Hioide/diagnóstico por imagem , Osso Hioide/lesões , Lactente , Masculino , Pessoa de Meia-Idade , Cartilagem Tireóidea/diagnóstico por imagem , Cartilagem Tireóidea/lesões , Adulto Jovem
13.
J Infect Dis ; 217(6): 1000-1010, 2018 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-29216383

RESUMO

Background: Postdiarrheal hemolytic-uremic syndrome (D+HUS) following Shiga toxin-producing Escherichia coli (STEC) infection is a serious condition lacking specific treatment. Host immune dysregulation and genetic susceptibility to complement hyperactivation are implicated in non-STEC-related HUS. However, genetic susceptibility to D+HUS remains largely uncharacterized. Methods: Patients with culture-confirmed STEC diarrhea, identified through the Centers for Disease Control and Prevention FoodNet surveillance system (2007-2012), were serotyped and classified by laboratory and/or clinical criteria as having suspected, probable, or confirmed D+HUS or as controls and underwent genotyping at 200 loci linked to nondiarrheal HUS or similar pathologies. Genetic associations with D+HUS were explored by multivariable regression, with adjustment for known risk factors. Results: Of 641 enrollees with STEC O157:H7, 80 had suspected D+HUS (41 with probable and 32 with confirmed D+HUS). Twelve genes related to cytokine signaling, complement pathways, platelet function, pathogen recognition, iron transport, and endothelial function were associated with D+HUS in multivariable-adjusted analyses (P ≤ .05). Of 12 significant single-nucleotide polymorphisms (SNPs), 5 were associated with all levels of D+HUS (intergenic SNP rs10874639, TFRC rs3804141, EDN1 rs5370, GP1BA rs121908064, and B2M rs16966334), and 7 SNPs (6 non-complement related) were associated with confirmed D+HUS (all P < .05). Conclusions: Polymorphisms in many non-complement-related genes may contribute to D+HUS susceptibility. These results require replication, but they suggest novel therapeutic targets in patients with D+HUS.


Assuntos
Centers for Disease Control and Prevention, U.S. , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/microbiologia , Predisposição Genética para Doença , Síndrome Hemolítico-Urêmica/genética , Escherichia coli Shiga Toxigênica/patogenicidade , Adolescente , Criança , Pré-Escolar , Diarreia/complicações , Diarreia/microbiologia , Feminino , Síndrome Hemolítico-Urêmica/patologia , Humanos , Masculino , Fatores de Risco , Estados Unidos
14.
MMWR Morb Mortal Wkly Rep ; 66(15): 397-403, 2017 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-28426643

RESUMO

Foodborne diseases represent a substantial public health concern in the United States. CDC's Foodborne Diseases Active Surveillance Network (FoodNet) monitors cases reported from 10 U.S. sites* of laboratory-diagnosed infections caused by nine enteric pathogens commonly transmitted through food. This report describes preliminary surveillance data for 2016 on the nine pathogens and changes in incidences compared with 2013-2015. In 2016, FoodNet identified 24,029 infections, 5,512 hospitalizations, and 98 deaths caused by these pathogens. The use of culture-independent diagnostic tests (CIDTs) by clinical laboratories to detect enteric pathogens has been steadily increasing since FoodNet began surveying clinical laboratories in 2010 (1). CIDTs complicate the interpretation of FoodNet surveillance data because pathogen detection could be affected by changes in health care provider behaviors or laboratory testing practices (2). Health care providers might be more likely to order CIDTs because these tests are quicker and easier to use than traditional culture methods, a circumstance that could increase pathogen detection (3). Similarly, pathogen detection could also be increasing as clinical laboratories adopt DNA-based syndromic panels, which include pathogens not often included in routine stool culture (4,5). In addition, CIDTs do not yield isolates, which public health officials rely on to distinguish pathogen subtypes, determine antimicrobial resistance, monitor trends, and detect outbreaks. To obtain isolates for infections identified by CIDTs, laboratories must perform reflex culture†; if clinical laboratories do not, the burden of culturing falls to state public health laboratories, which might not be able to absorb that burden as the adoption of these tests increases (2). Strategies are needed to preserve access to bacterial isolates for further characterization and to determine the effect of changing trends in testing practices on surveillance.


Assuntos
Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/estatística & dados numéricos , Microbiologia de Alimentos , Parasitologia de Alimentos , Doenças Transmitidas por Alimentos/diagnóstico , Doenças Transmitidas por Alimentos/epidemiologia , Vigilância da População , Técnicas de Cultura/estatística & dados numéricos , Humanos , Incidência , Estados Unidos/epidemiologia
15.
Alcohol Clin Exp Res ; 41(3): 571-575, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28129435

RESUMO

BACKGROUND: Use of alcohol and select other drugs confer risk for injury deaths, yet how such use compares in different types of injury deaths including suicide and fatal motor vehicle collisions (MVCs) is unclear. METHODS: Individuals in New Mexico ages 18 to 54 that died in 2012 by suicide or MVC were analyzed. Toxicology results were used to code the presence of alcohol and the presence of 1 or more drugs including cocaine, opiate (oxycodone, heroin, etc.), or amphetamine or methamphetamine, yielding a 4-category variable: Alcohol + Drug, Alcohol (without drug), Drug (without alcohol), and Neither (ref). Suicides were compared to MVCs (ref) using unconditional logistic regression analyses adjusted for sex, age, and ethnicity. Poisoning suicides were removed prior to analyses to exclude cases where the drugs may have been used to hasten death. RESULTS: Analyses were based on 185 suicides and 161 MVCs. Alcohol + Drug was more likely in suicide decedents, AOR (95% CI) = 4.33 (1.70, 11.03). Alcohol (without drug) and Drug (without alcohol) did not differ between the groups. Uniquely, all suicides that were positive for cocaine were also positive for alcohol. As follow-up, similar results were obtained in a post hoc analysis that limited the drug exposure variable to cocaine: Alcohol + Cocaine, AOR (95% CI) = 4.69 (1.59, 13.88). CONCLUSIONS: The co-presence of alcohol and 1 or more drugs of abuse, particularly cocaine, may be more likely in suicide deaths compared to MVCs. Results may inform prevention efforts targeting specific substances and types of injury.


Assuntos
Acidentes de Trânsito , Consumo de Bebidas Alcoólicas/sangue , Cocaína/sangue , Etanol/sangue , Suicídio , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/mortalidade , Anfetaminas/sangue , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Alcaloides Opiáceos/sangue , Adulto Jovem
16.
J Forensic Sci ; 62(3): 668-673, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28000209

RESUMO

While it is recognized that veterans have increased rates of depression, post-traumatic stress disorder (PTSD), suicide, and substance use disorders, rates of homicide and unintentional injury deaths in veterans have been minimally investigated. We evaluated all non-natural deaths in New Mexico veterans between 2002 and 2011 in comparison with non-natural deaths among non-veterans. We reviewed all decedents in New Mexico with a history of military service and investigated by the medical examiner, excluding natural deaths and deaths due to fall from standing height. The most common manner of death was unintentional injury (62%), most of these deaths due to motor vehicle accidents (29%) followed by unintentional overdose (26%). Suicide rates among veterans were consistently higher than the general population. The most common mechanism of suicide in men was gunshot wound (72%), and intentional overdose in women (49%). Services are needed for veterans that are tailored to all ages and both sexes.


Assuntos
Causas de Morte , Veteranos/estatística & dados numéricos , Acidentes/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Médicos Legistas , Overdose de Drogas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New Mexico/epidemiologia , Estudos Retrospectivos , Distribuição por Sexo , Suicídio/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Adulto Jovem
17.
Arch Pathol Lab Med ; 141(1): 82-84, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27608262

RESUMO

CONTEXT: -Medical examiners and coroners have long been an integral component of public health, often being the first to recognize and describe emerging infectious diseases. Given their experience and access, medical examiners and coroners will provide valuable contributions to better understanding Zika virus infection and its sequelae. OBJECTIVE: -To review past examples of medical examiner/coroner involvement in recognition of emerging infectious diseases and describe how medical examiners and coroners will be critical in understanding the pathophysiology of Zika infections. DESIGN: -Review of the existing literature on the role of medical examiners and coroners in the identification of emergent infections and the available literature on Zika virus. RESULTS: -Medical examiners and coroners have played a crucial role in identifying numerous emerging infectious diseases such as hantavirus pulmonary syndrome and West Nile virus, and have the expertise and experience to aid in elucidating the pathophysiologic effects of Zika virus and tracking its distribution and risk factors. CONCLUSIONS: -Medical examiners and coroners will be a significant factor in the unified public health approach needed to mitigate the effects of Zika virus and other, heretofore unrecognized, infectious diseases.


Assuntos
Doenças Transmissíveis Emergentes/virologia , Médicos Legistas , Papel Profissional , Infecção por Zika virus/virologia , Zika virus/fisiologia , Autopsia/normas , Doenças Transmissíveis Emergentes/diagnóstico , Doenças Transmissíveis Emergentes/fisiopatologia , Coleta de Dados/normas , Humanos , Patologia Clínica/métodos , Patologia Clínica/normas , Saúde Pública/normas , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/fisiopatologia
18.
J Forensic Sci ; 61(6): 1563-1570, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27787896

RESUMO

Projectile components that are traditionally radiolucent can be of considerable importance in determination of weapon type and caliber, but they are often missed on evaluation of postmortem radiographs. We hypothesized that these components would be significantly better visualized by evaluation of computed tomography (CT) scans compared to the practice standard of radiography alone. In this project, potentially radiolucent projectile components were both pulled apart and fired, and the radiolucent components were recovered. These components were embedded in blocks of ballistics gelatin and were imaged using both radiography and CT. The scans were evaluated by three blinded, board-certified radiologists for the presence/absence of projectile components and true-negative regions in each block. If a radiologist indicated visualization of a projectile component, they were further requested to describe their observation. It was found that traditionally radiolucent projectile components are not significantly more often identified on CT scans than radiography (p < 0.05).

19.
Drug Alcohol Depend ; 167: 29-35, 2016 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-27507658

RESUMO

PURPOSE: Drug overdose deaths are epidemic in the U.S. Prescription opioid pain relievers (OPR) and heroin account for the majority of drug overdoses. Preventing death after an opioid overdose by naloxone administration requires the rapid identification of the overdose by witnesses. This study used a state medical examiner database to characterize fatal overdoses, evaluate witness-reported signs of overdose, and identify opportunities for intervention. METHODS: We reviewed all unintentional drug overdose deaths that occurred in New Mexico during 2012. Data were abstracted from medical examiner records at the New Mexico Office of the Medical Investigator. We compared mutually exclusive groups of OPR and heroin-related deaths. RESULTS: Of the 489 overdose deaths reviewed, 49.3% involved OPR, 21.7% involved heroin, 4.7% involved a mixture of OPR and heroin, and 24.3% involved only non-opioid substances. The majority of OPR-related deaths occurred in non-Hispanic whites (57.3%), men (58.5%), persons aged 40-59 years (55.2%), and those with chronic medical conditions (89.2%). Most overdose deaths occurred in the home (68.7%) and in the presence of bystanders (67.7%). OPR and heroin deaths did not differ with respect to paramedic dispatch and CPR delivery, however, heroin overdoses received naloxone twice as often (20.8% heroin vs. 10.0% OPR; p<0.01). CONCLUSION: OPR overdose deaths differed by age, health status, and the presence of bystanders, yet received naloxone less often when compared to heroin overdose deaths. These findings suggest that naloxone education and distribution should be targeted in future prevention efforts.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Heroína/envenenamento , Adulto , Fatores Etários , Overdose de Drogas/etiologia , Overdose de Drogas/prevenção & controle , Serviços Médicos de Emergência/métodos , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , New Mexico/epidemiologia
20.
MMWR Morb Mortal Wkly Rep ; 65(14): 368-71, 2016 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-27077946

RESUMO

To evaluate progress toward prevention of enteric and foodborne illnesses in the United States, the Foodborne Diseases Active Surveillance Network (FoodNet) monitors the incidence of laboratory-confirmed infections caused by nine pathogens transmitted commonly through food in 10 U.S. sites. This report summarizes preliminary 2015 data and describes trends since 2012. In 2015, FoodNet reported 20,107 confirmed cases (defined as culture-confirmed bacterial infections and laboratory-confirmed parasitic infections), 4,531 hospitalizations, and 77 deaths. FoodNet also received reports of 3,112 positive culture-independent diagnostic tests (CIDTs) without culture-confirmation, a number that has markedly increased since 2012. Diagnostic testing practices for enteric pathogens are rapidly moving away from culture-based methods. The continued shift from culture-based methods to CIDTs that do not produce the isolates needed to distinguish between strains and subtypes affects the interpretation of public health surveillance data and ability to monitor progress toward prevention efforts. Expanded case definitions and strategies for obtaining bacterial isolates are crucial during this transition period.


Assuntos
Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/estatística & dados numéricos , Microbiologia de Alimentos , Doenças Transmitidas por Alimentos/diagnóstico , Doenças Transmitidas por Alimentos/epidemiologia , Vigilância da População , Técnicas de Cultura/estatística & dados numéricos , Humanos , Incidência , Estados Unidos/epidemiologia
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