RESUMO
Enterotoxigenic Escherichia coli (ETEC) is a well-established cause of traveller's diarrhoea and occasional domestic foodborne illness outbreaks in the USA. Although ETEC are not detected by conventional stool culture methods used in clinical laboratories, syndromic culture-independent diagnostic tests (CIDTs) capable of detecting ETEC have become increasingly prevalent in the last decade. This study describes the epidemiology of ETEC infections reported to the Minnesota Department of Health (MDH) during 2016-2017. ETEC-positive stool specimens were submitted to MDH to confirm the presence of ETEC DNA by polymerase chain reaction (PCR). Cases were interviewed to ascertain illness and exposures. Contemporaneous Salmonella cases were used as a comparison group in a case-case comparison analysis of risk factors. Of 222 ETEC-positive specimens received by MDH, 108 (49%) were concordant by PCR. ETEC was the sixth most frequently reported bacterial enteric pathogen among a subset of CIDT-positive specimens. Sixty-nine (64%) laboratory-confirmed cases had an additional pathogen codetected with ETEC, including enteroaggregative E. coli (n = 40) and enteropathogenic E. coli (n = 39). Although travel is a risk factor for ETEC infection, only 43% of cases travelled internationally, providing evidence for ETEC as an underestimated source of domestically acquired enteric illness in the USA.
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Escherichia coli Enterotoxigênica , Infecções por Escherichia coli/epidemiologia , Vigilância da População , Feminino , Doenças Transmitidas por Alimentos/epidemiologia , Gastroenteropatias/epidemiologia , Gastroenteropatias/microbiologia , Humanos , Masculino , Minnesota/epidemiologia , Reação em Cadeia da Polimerase Multiplex/métodos , Estudos Retrospectivos , Estações do AnoRESUMO
Net blotch, caused by Pyrenophora teres, is a major barley (Hordeum vulgare) leaf disease worldwide. P. teres occurs as two forms-P. teres f. teres, and P. teres f. maculata-inducing net and spot-like symptoms, respectively. An intact-seedling assay, where entire seedlings are inoculated by spraying with a conidial suspension, is frequently used for phenotyping net blotch. However, this presents a biosecurity risk in the glasshouse when nonlocal isolates are being screened. Alternatively, a detached-leaf assay (DLA-droplet method) can be used in which leaf segments laid out in a covered tray are inoculated with droplets of a conidial suspension, confining the inoculum. However, using this method, net and spot form symptoms cannot be distinguished from each other. We have developed an improved DLA (DLA-spray method) in which detached whole leaves are sprayed with the inoculum to produce distinct lesions. We compare the results for the three phenotyping methods above using four isolates from both net and spot forms of the disease to inoculate a standard set of eight barley genotypes. Results indicate that the DLA-spray method is a functional, informative and rapid test that readily differentiates the two forms of the pathogen in a biosecure environment.
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Ascomicetos/isolamento & purificação , Hordeum/microbiologia , Doenças das Plantas/microbiologia , Folhas de Planta/microbiologia , Ascomicetos/fisiologia , Hordeum/genética , PlântulaRESUMO
The BioFire FilmArray® Gastrointestinal Panel (GIP) was implemented to replace traditional stool culture and enzyme immunoassay (EIA) testing for stool pathogens. The purpose of this study was to evaluate the detection rate, incidence of coinfection, and culture recovery rate of gastrointestinal (GI) pathogens detected by the GIP over a 1-year period. A total of 2257 stools collected from January to December 2015 were tested using the GIP. Clostridium difficile colonization was also evaluated by an antigen/toxin EIA and confirmatory polymerase chain reaction (PCR). The GIP detected one pathogen in 911 (40.4%) specimens. Coinfections were detected in 176 (7.8%) of these specimens. The most frequently detected pathogens were C. difficile (15.2%), norovirus (8.9%), enteropathogenic Escherichia coli (7.1%), enteroaggregative E. coli (3.4%), Campylobacter spp. (2.3%), and sapovirus (2.0%). Each of the remaining GIP targets had a detection rate of ≤1.6%. The recovery of bacteria for public health investigations varied, with rates as high as 77% for Salmonella to as low as 30% for Yersinia enterocolitica. Of stools positive for C. difficile on the GIP that were tested by EIA, only 42.7% (88/206) were found to be producing detectable toxin. Overall, the implementation of the GIP resulted in high detection rates of GI pathogens, including the frequent detection of coinfections. This is a promising test to streamline the testing of agents causing infectious gastroenteritis from multiple tests down to a single order with limited hands-on time. Ongoing studies will need to assess the impact that the GIP has on downstream patient care and public health practices.
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Infecções Bacterianas/diagnóstico , Coinfecção/diagnóstico , Testes Diagnósticos de Rotina/métodos , Gastroenterite/diagnóstico , Técnicas Microbiológicas/métodos , Viroses/diagnóstico , Centros Médicos Acadêmicos , Infecções Bacterianas/microbiologia , Coinfecção/microbiologia , Coinfecção/virologia , Gastroenterite/microbiologia , Gastroenterite/virologia , Hospitais , Humanos , Meio-Oeste dos Estados Unidos , Viroses/virologiaRESUMO
BACKGROUND: The purpose of this study was to examine hospital mortality, long-term mortality, and health service utilization among critically ill patients. We also determined whether these outcomes differed according to demographic and clinical characteristics. METHODS: We conducted a retrospective cohort study of adults (age ≥ 18 years) who survived admission to an intensive care unit (ICU) in Ontario, Canada, between 1 April 2002 and 31 March 2012, excluding isolated admissions to step-down or intermediate ICUs, coronary care ICUs, or cardiac surgery ICUs. Adults (age ≥ 18 years) who survived an acute hospitalization that did not include an ICU stay formed the comparator group. The primary outcome was mortality following hospital discharge. Secondary outcomes were healthcare utilization, including emergency room admissions and hospital readmissions during follow-up. RESULTS: Over the study interval, 500,124 patients were admitted to ICUs and 420,187 (84%) survived to hospital discharge. Median follow-up for survivors was 5.3 (interquartile range 2.5, 8.2) years. Patients admitted to an ICU were more likely to subsequently visit the emergency department, be readmitted to the hospital and ICU, receive home care support, require rehabilitation, and be admitted for long-term care. Those requiring more resources within the ICU required more resources after discharge. One-third of patients admitted to the ICU died during long-term follow-up, with overall probabilities of death of 11% and 29% at 1 year and 5 years, respectively. In the adjusted analysis, there was an increasing hazard of death with increasing age, reaching a hazard ratio of 18.08 (95 % confidence interval 16.60-19.68) for those ≥ 85 years of age compared with those aged 18-24 years. CONCLUSIONS: Healthcare utilization after hospital discharge was higher among ICU patients, and also among those requiring more healthcare resources during their ICU admission, than among all hospitalized patients as a group. One-third of ICU patients died within the 5 years following discharge, and age was the most influential determinant of outcome. These findings should help target post-ICU discharge services for high-risk groups and better inform goals-of-care discussions for elderly critically ill patients.
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Estado Terminal/mortalidade , Atenção à Saúde/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Assistência de Longa Duração/estatística & dados numéricos , Avaliação de Resultados da Assistência ao Paciente , Readmissão do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Ontário , Estudos Retrospectivos , Sobreviventes/estatística & dados numéricosRESUMO
HypothesisFoaming in diesel fuels is not well understood and leads to operational challenges. To combat deleterious effects of foaming, diesel formulations can include additives called antifoams. Existing antifoams, unfortunately, are inherently ash-generating when combusted, with unknown environmental impacts. They are prohibited in certain countries, so identifying effective alternative ash-free antifoam chemistries is needed. ExperimentsWe conduct systematic characterization of foam stabilization and antifoaming mechanisms in diesel for two different antifoams (silicone-containing & ashless chemistries). Employing a custom technique combining single-bubble/single-antifoam-droplet manipulation with white light interferometry, we also obtain mechanistic insights into foam stability and antifoam dynamics. ResultsCoalescence times from both bulk foam and single bubble experiments confirm ashless antifoams are effective at reducing foaming, demonstrating the potential of ashless antifoams. Further, we perform single-antifoam-droplet experiments and obtain direct experimental evidence revealing the elusive antifoaming mechanisms. Interestingly, the silicone-containing and ashless antifoams seemingly function via two different mechanisms: spreading and dewetting respectively. This surprising finding refutes conventional wisdom that spreading is likely the only antifoam mechanism in diesels. These results and the reported experimental framework significantly enhance the scientific understanding of non-aqueous foams and will accelerate the engineering of alternative antifoam chemistries for non-aqueous systems.
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OBJECTIVE: This study aimed to evaluate a new method for preparing vaginal wet preparations to enable quantification of cells and lactobacilli. The current nonstandardized technique allows for a variable amount of vaginal fluid collected, diluted by a variable amount of saline/KOH, and no quantification of constituents. MATERIALS: The vaginal fluids from 100 randomly selected women without vulvovaginitis symptoms presenting to the author's practice at Mayo Clinic underwent analysis by the quantification technique. Women were excluded if they were younger than 18 years, had antibiotics within the past 2 months, currently on their period, had placed anything in the vagina for the past 24 hours, used Depo-Provera, or were lactating. METHODS: All the wet preparations were made by mixing the natural vaginal fluids with 3 mL of sterile normal saline. Spinal diluting fluid was added to the saline preparation. The saline and KOH mixtures were injected into separate wells of KOVA Glasstic Grid Slide and analyzed with a phase-contrast microscope at 40× and 60×. The concentration of leukocytes, lactobacilli, and squamous cells and the degree of maturation of the majority (>50%) of squamous cells were assessed, and it was determined whether there was excessive non-lactobacilli bacteria (EB) as evident by clumps of bacteria in the background fluid and speckling on the squamous cells. RESULTS: The 3 most common patterns to occur were as follows: First, 51% (95% confidence interval [CI] = 41%-60%) of the total specimens had abundant lactobacilli, no leukocytes, more than 50% fully maturated squamous cells, and no EB. Second, 22% (95% CI = 14%-32%) of the total specimens had low lactobacilli counts, no leukocytes, more than 50% undermaturated squamous cells, and no EB. Third, 12% (95% CI = 6%-20%) of the total specimens had abundant lactobacilli, leukocytes, more than 50% fully maturated squamous cells, and no EB. CONCLUSIONS: It is imperative to be able to objectively quantify normal vaginal secretion constituents so that (1) the abnormal patterns can be demarcated and (2) treatment targets of what constitutes healthy vaginal conditions can be provided.
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Técnicas Bacteriológicas/métodos , Líquidos Corporais/citologia , Líquidos Corporais/microbiologia , Técnicas Citológicas/métodos , Manejo de Espécimes/métodos , Vagina/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bactérias , Carga Bacteriana , Contagem de Células , Células Epiteliais/citologia , Fabaceae , Feminino , Humanos , Lactobacillales/classificação , Lactobacillales/isolamento & purificação , Leucócitos/citologia , Pessoa de Meia-Idade , Vagina/citologia , Vagina/microbiologia , Adulto JovemRESUMO
BACKGROUND: The Choosing Wisely Campaign was launched in 2012 and has been applied to a broad spectrum of disciplines in almost thirty countries, with the objective of reducing unnecessary or potentially harmful investigations and procedures, thus limiting costs and improving outcomes. In Canada, patients with burn injuries are usually initially assessed by primary care and emergency providers, while plastic or general surgeons provide ongoing management. We sought to develop a series of Choosing Wisely statements for burn care to guide these practitioners and inform suitable, cost-effective investigations and treatment choices. METHODS: The Choosing Wisely Canada list for Burns was developed by members of the Canadian Special Interest Group of the American Burn Association. Eleven recommendations were generated from an initial list of 29 statements using a modified Delphi process and SurveyMonkey™. RESULTS: Recommendations included statements on avoidance of prophylactic antibiotics, restriction of blood products, use of adjunctive analgesic medications, monitoring and titration of opioid analgesics, and minimizing 'routine' bloodwork, microbiology or radiological investigations. CONCLUSIONS: The Choosing Wisely recommendations aim to encourage greater discussion between those involved in burn care, other health care professionals, and their patients, with a view to reduce the cost and adverse effects associated with unnecessary therapeutic and diagnostic procedures, while still maintaining high standards of evidence-based burn care.
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Queimaduras , Procedimentos Desnecessários , Analgésicos Opioides/uso terapêutico , Queimaduras/tratamento farmacológico , Canadá , Humanos , Sociedades Médicas , Estados UnidosRESUMO
BACKGROUND: Exercise-induced pulmonary arterial hypertension (EIPAH) is associated with reduced peak exercise cardiac output (CO) and aerobic capacity (peak ). We investigated the validity of the encouraged 6-min walk test (6MWT) to identify exercise limitation and estimate aerobic capacity in subjects with EIPAH. METHODS: Seventeen subjects with EIPAH (56 ± 14 years, 15 women) and 20 healthy controls (57 ± 13 years, 19 women) underwent two encouraged 6MWTs and a symptom-limited cardiopulmonary exercise test (CPET). To measure central haemodynamics, subjects with EIPAH performed the CPET with a pulmonary artery catheter in situ. RESULTS: Compared with controls, subjects with EIPAH had reduced peak (1.2 ± 0.4 vs 1.7 ± 0.5, L/min, P < 0.01), 6-min walk distance (6MWD) (575 ± 86 vs 669 ± 76 m, P < 0.001) and 6-min walk work (6MWW) (39 ± 11 vs 45 ± 7 km.kg, P < 0.01). In subjects with EIPAH, there was a moderate correlation between 6MWD and peak (r= 0.72, P < 0.01) and a strong correlation between 6MWW and peak (r= 0.86, P < 0.001). There were significant correlations between 6MWD and peak CO (r= 0.59, P < 0.05), and between peak and peak CO (r= 0.55, P < 0.05). Peak heart rate was similar in the CPET and 6MWT in subjects with EIPAH (133 ± 15 vs 133 ± 19 beats/min, P= 0.8). CONCLUSIONS: The encouraged 6MWT identifies reduced exercise capacity and provides a valid estimate of aerobic capacity in EIPAH.
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Teste de Esforço/normas , Tolerância ao Exercício/fisiologia , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/fisiopatologia , Caminhada , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Bases de Dados Factuais , Exercício Físico/fisiologia , Teste de Esforço/métodos , Hipertensão Pulmonar Primária Familiar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
The purpose of this investigation was to identify when diagnostic testing and empirical antiviral therapy should be considered for adult patients requiring hospitalization during influenza seasons. During the 2007/8 influenza season, six acute care hospitals in the Greater Toronto Area participated in active surveillance for laboratory-confirmed influenza requiring hospitalization. Nasopharyngeal (NP) swabs were obtained from patients presenting with acute respiratory or cardiac illness, or with febrile illness without clear non-respiratory etiology. Predictors of influenza were analyzed by multivariable logistic regression analysis and likelihoods of influenza infection in various patient groups were calculated. Two hundred and eighty of 3,917 patients were found to have influenza. Thirty-five percent of patients with influenza presented with a triage temperature >or=38.0 degrees C, 80% had respiratory symptoms in the emergency department, and 76% were >or=65 years old. Multivariable analysis revealed a triage temperature >or=38.0 degrees C (odds ratio [OR] 3.1; 95% confidence interval [CI] 2.3-4.1), the presence of respiratory symptoms (OR 1.7; 95% CI 1.2-2.4), admission diagnosis of respiratory infection (OR 1.8; 95% CI 1.3-2.4), admission diagnosis of exacerbation of chronic obstructive pulmonary disease (COPD)/asthma or respiratory failure (OR 2.3; 95% CI 1.6-3.4), and admission in peak influenza weeks (OR 4.2; 95% CI 3.1-5.7) as independent predictors of influenza. The likelihood of influenza exceeded 15% in patients with respiratory infection or exacerbation of COPD/asthma if the triage temperature was >or=38.0 degrees C or if they were admitted in the peak weeks during the influenza season. During influenza season, diagnostic testing and empiric antiviral therapy should be considered in patients requiring hospitalization if respiratory infection or exacerbation of COPD/asthma are suspected and if either the triage temperature is >or=38.0 degrees C or admission is during the weeks of peak influenza activity.
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Hospitalização/estatística & dados numéricos , Influenza Humana/epidemiologia , Influenza Humana/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nasofaringe/virologia , Adulto JovemRESUMO
PURPOSE: To explore contemporary clincial case management of patients with Ebola virus disease. METHODS: A narrative review from a clinical perspective of clinical features, diagnostic tests, treatments and outcomes of patients with Ebola virus disease. RESULTS: Substantial advances have been made in the care of patients with Ebola virus disease (EVD), precipitated by the unprecedented extent of the 2014-2016 outbreak. There has been improved point-of-care diagnostics, improved characterization of the clinical course of EVD, improved patient-optimized standards of care, evaluation of effective anti-Ebola therapies, administration of effective vaccines, and development of innovative Ebola treatment units. A better understanding of the Ebola virus disease clinical syndrome has led to the appreciation of a central role for critical care clinicians-over 50% of patients have life-threatening complications, including hypotension, severe electrolyte imbalance, acute kidney injury, metabolic acidosis and respiratory failure. Accordingly, patients often require critical care interventions such as monitoring of vital signs, intravenous fluid resuscitation, intravenous vasoactive medications, frequent diagnostic laboratory testing, renal replacement therapy, oxygen and occasionally mechanical ventilation. CONCLUSION: With advanced training and adherence to infection prevention and control practices, clinical interventions, including critical care, are feasible and safe to perform in critically ill patients. With specific anti-Ebola medications, most patients can survive Ebola virus infection.
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Estado Terminal/terapia , Doença pelo Vírus Ebola/fisiopatologia , Avaliação de Resultados em Cuidados de Saúde/normas , Anticorpos Monoclonais/uso terapêutico , Estado Terminal/epidemiologia , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Ebolavirus/efeitos dos fármacos , Ebolavirus/patogenicidade , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/terapia , Humanos , Avaliação de Resultados em Cuidados de Saúde/tendências , Padrão de Cuidado/tendênciasRESUMO
One variant of a complex satellite DNA of the Bermuda land crab is significantly longer than the average repeat unit of the satellite. The extra DNA in the variant is accounted for by a fivefold tandem amplification of a 0.142-kilobase sequence. The amplified sequence is bounded by a tetranucleotide inverted repeat; the upstream arm of the inverted repeat is missing from two other variants of the satellite. The latter variants contain only one copy of a sequence that is closely related to the amplified sequence. By contrast, in several satellite DNA's of other organisms, extra DNA is inserted.
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DNA Satélite/genética , Amplificação de Genes , Animais , Sequência de Bases , Braquiúros/genética , Inversão Cromossômica , Conformação de Ácido NucleicoRESUMO
The D-amino acid oxidase activator (DAOA, previously known as G72) gene, mapped on 13q33, has been reported to be genetically associated with bipolar disorder (BP) in several populations. The consistency of associated variants is unclear and rare variants in exons of the DAOA gene have not been investigated in psychiatric diseases. We employed a conditional linkage method-STatistical Explanation for Positional Cloning (STEPC) to evaluate whether any associated single nucleotide polymorphisms (SNPs) account for the evidence of linkage in a pedigree series that previously has been linked to marker D13S779 at 13q33. We also performed an association study in a sample of 376 Caucasian BP parent-proband trios by genotyping 38 common SNPs in the gene region. Besides, we resequenced coding regions and flanking intronic sequences of DAOA in 555 Caucasian unrelated BP patients and 564 mentally healthy controls, to identify putative functional rare variants that may contribute to disease. One SNP rs1935058 could "explain" the linkage signal in the family sample set (P = 0.055) using STEPC analysis. No significant allelic association was detected in an association study by genotyping 38 common SNPs in 376 Caucasian BP trios. Resequencing identified 53 SNPs, of which 46 were novel SNPs. There was no significant excess of rare variants in cases relative to controls. Our results suggest that DAOA does not have a major effect on BP susceptibility. However, DAOA may contribute to bipolar susceptibility in some specific families as evidenced by the STEPC analysis.
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Transtorno Bipolar/enzimologia , Transtorno Bipolar/genética , Proteínas de Transporte/genética , Polimorfismo de Nucleotídeo Único/genética , Clonagem Molecular , Éxons/genética , Feminino , Predisposição Genética para Doença , Humanos , Peptídeos e Proteínas de Sinalização Intracelular , Masculino , Análise de Sequência de DNARESUMO
BACKGROUND: Despite the fact that outreach and early warning systems (EWS) are an integral part of a hospital wide systems approach to improve the early identification and management of deteriorating patients on general hospital wards, the widespread implementation of these interventions in practice is not based on robust research evidence. OBJECTIVES: The primary objective was to determine the impact of critical care outreach services on hospital mortality rates. Secondary objectives included determining the effect of outreach services on intensive care unit (ICU) admission patterns, length of hospital stay and adverse events. SEARCH STRATEGY: The review authors searched the following electronic databases: EPOC Specialised Register, The Cochrane Central Register of Controlled Trials (CENTRAL) and other Cochrane databases (all on The Cochrane Library 2006, Issue 3), MEDLINE (1996-June week 3 2006), EMBASE (1974-week 26 2006), CINAHL (1982-July week 5 2006), First Search (1992-2005) and CAB Health (1990-July 2006); also reference lists of relevant articles, conference abstracts, and made contact with experts and critical care organisations for further information. SELECTION CRITERIA: Randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series designs (ITS) which measured hospital mortality, unanticipated ICU admissions, ICU readmissions, length of hospital stay and adverse events following implementation of outreach and EWS in a general hospital ward to identify deteriorating adult patients versus general hospital ward setting without outreach and EWS were included in the review. DATA COLLECTION AND ANALYSIS: Three review authors independently extracted data and two review authors assessed the methodological quality of the included studies. Meta-analysis was not possible due to heterogeneity. Summary statistics and descriptive summaries of primary and secondary outcomes are presented for each study. MAIN RESULTS: Two cluster-randomised control trials were included: one randomised at hospital level (23 hospitals in Australia) and one at ward level (16 wards in the UK). The primary outcome in the Australian trial (a composite score comprising incidence of unexpected cardiac arrests, unexpected deaths and unplanned ICU admissions) showed no statistical significant difference between control and medical emergency team (MET) hospitals (adjusted P value 0.640; adjusted odds ratio (OR) 0.98; 95% confidence interval (CI) 0.83 to 1.16). The UK-based trial found that outreach reduced in-hospital mortality (adjusted OR 0.52; 95% CI 0.32 to 0.85) compared with the control group. AUTHORS' CONCLUSIONS: The evidence from this review highlights the diversity and poor methodological quality of most studies investigating outreach. The results of the two included studies showed either no evidence of the effectiveness of outreach or a reduction in overall mortality in patients receiving outreach. The lack of evidence on outreach requires further multi-site RCT's to determine potential effectiveness.
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Estado Terminal/mortalidade , Parada Cardíaca/mortalidade , Mortalidade Hospitalar , Unidades de Terapia Intensiva , Adulto , Humanos , Tempo de Internação , Admissão do Paciente/estatística & dados numéricos , Quartos de Pacientes , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: To define the existence of 2 patterns of altered vaginal flora in symptomatic women identified on wet preparations that are not in the current vaginitis classification system. STUDY DESIGN: Testing of vaginal secretions from gynecologic patients at Mayo Clinic, Scottsdale, Arizona, who presented with vulvo-vaginal symptoms by vaginal pH, whiff testing, and saline and potassium hydroxide wet preparations. Over 14 years, approximately 5,000 samples were analyzed. Wet preparations were analyzed under low- (x 100) and high-power (x 400) phase-contrast microscopy. RESULTS: The first pattern has mixed bacteria with few or no lactobacilli, increased leukocytes and elevated pH. This pattern has a spectrum of severity, with the severe form meeting the diagnostic definition of desquamative inflammatory vaginitis. The mild-to-moderate form, termed inflammatory vaginitis, falls outside established diagnostic categories. The second pattern also has a spectrum of severity. The mild-to-moderate form, termed noninflammatory vaginosis, has mixed bacteria speckling squamous cells (but not obscuring edges), few or no lactobacilli, no leukocyte response and mildly elevated pH. This form differs from the severe form, which meets Amsel's criteria for bacterial vaginosis. CONCLUSION: The current classification system requires revision because it oversimplifies and ignores the full spectrum of altered vaginal microflora.
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Vaginite/classificação , Vaginite/etiologia , Feminino , Humanos , Concentração de Íons de Hidrogênio , Vagina/química , Vagina/microbiologia , Vaginite/patologiaRESUMO
Zika virus (ZIKAV) is classically described as causing minor symptoms in adult patients, however neurologic complications have been recognized. The recent outbreak in Central and South America has resulted in serious illness in some adult patients. We report adult patients in Latin America diagnosed with ZIKAV infection admitted to Intensive Care Units (ICUs). METHODS: Multicenter, prospective case series of adult patients with laboratory diagnosis of ZIKAV in 16 ICUs in 8 countries. RESULTS: Between December 1st 2015 and April 2nd 2016, 16 ICUs in 8 countries enrolled 49 critically ill patients with diagnosis of ZIKAV infection. We included 10 critically ill patients with ZIKAV infection, as diagnosed with RT-PCR, admitted to the ICU. Neurologic manifestations concordant with Guillain-Barre Syndrome (GBS) were present in all patients, although 2 evolved into an encephalitis-like picture. 2 cases died, one due to encephalitis, the other septic shock. CONCLUSIONS: Differing from what was usually reported, ZIKAV infection can result in life-threatening neurologic illness in adults, including GBS and encephalitis. Collaborative reporting to identify severe illness from an emerging pathogen can provide valuable insights into disease epidemiology and clinical presentation, and inform public health authorities about acute care priorities.
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Surtos de Doenças , Encefalite Viral/complicações , Síndrome de Guillain-Barré/complicações , Infecção por Zika virus/epidemiologia , APACHE , Adulto , Idoso , Cuidados Críticos , Estado Terminal/epidemiologia , Encefalite Viral/virologia , Feminino , Síndrome de Guillain-Barré/virologia , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , América do Sul/epidemiologia , Adulto Jovem , Zika virus , Infecção por Zika virus/complicaçõesRESUMO
A procedure for the determination of N-nitrosodiethanolamine (NDELA) in personal care products was evaluated in collaborative studies by member organizations of the United Kingdom's Cosmetic Toiletry and Perfumery Association (CTPA) and LGC Limited, formerly known as the Laboratory of the Government Chemist (LGC). Samples were prepared depending on the matrix of the cosmetic product: aqueous samples were prepared by diluting in water followed by solid-phase extraction; emulsions, oils and solid materials were dissolved in dichloromethane and extracted with water. NDELA was separated from the sample matrix using reverse-phase liquid chromatography. The N-nitroso bond was cleaved by photolysis to give nitrite, which was colorimetrically quantified. The nitrite functional group reacted with sulphanilamide in an acid medium to form a diazonium ion which was then coupled with N-(1-naphthyl)ethylenediamine dihydrochloride according to the Griess reaction to give a purple-coloured azo dye that absorbed at 540 nm. Compared with other published methods for NDELA, the method described here is quick and easy to use. It has the required sensitivity and specificity, and can accurately and reliably quantify NDELA in a wide range of personal care product matrices.
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Spontaneous mutation levels are kept low in most organisms by a variety of error-reducing mechanisms, some of which ensure a high level of fidelity during DNA replication. The mutT gene of Escherichia coli is an important participant in avoiding such replication mistakes. An inactive mutT allele is a strong mutator with strict mutational specificity: only A.T-->C.G transversions are enhanced. The biological role of the MutT protein is thought to be the prevention of A.G mispairs during replication, specifically the mispair involving a template A and an oxidized form of guanine, 8-oxoguanine, which results when the oxidized form of dGTP, 8-oxodGTP, is available as a polymerase substrate. MutT is part of an elaborate defense system that protects against the mutagenic effects of oxidized guanine as a part of substrate dGTP and chromosomal DNA. The A.G mispairings prevented by MutT are not well-recognized and/or repaired by other fidelity mechanisms such as proofreading and mismatch repair, accounting in part for the high mutator activity of mutT. MutT is a nucleoside triphosphatase with a preference for the syn form of dGTP, hydrolyzing it to dGMP and pyrophosphate. 8-oxodGTP is hydrolyzed 10 times faster than dGTP, making it a likely biological substrate for MutT. MutT is assumed to hydrolyze 8-oxodGTP in the nucleotide pool before it can be misincorporated. While the broad role of MutT in error avoidance seems resolved, important details that are still unclear are pointed out in this review.
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Proteínas de Bactérias/genética , Replicação do DNA , Proteínas de Escherichia coli , Escherichia coli/genética , Genes Bacterianos/fisiologia , Monoéster Fosfórico Hidrolases/genética , Proteínas de Bactérias/fisiologia , Sequência de Bases , Nucleotídeos de Desoxiguanina/metabolismo , Dados de Sequência Molecular , Monoéster Fosfórico Hidrolases/fisiologia , PirofosfatasesRESUMO
Imaging of cellular electric potential via calcium-ion sensitive contrast agents is a useful tool, but current it lacks sufficient depth penetration. We explore contrast-enhanced photoacoustic (PA) imaging, using Arsenazo III dye, to visualize cardiac myocyte depolarization in vitro. Phantom results show strong linearity of PA signal with dye concentration (R 2 > 0.95), and agree spectrally with extinction measurements with varying calcium concentration. Cell studies indicate a significant (> 100-fold) increase in PA signal for dye-treated cells, as well as a 10-fold increase in peak-to-peak variation during a 30-second window. This suggests contrast-enhanced PA imaging may have sufficient sensitivity and specificity for depth-resolved visualization of tissue depolarization in real-time.
RESUMO
The Enhancer (En) controlling element system in maize includes numerous alleles, one of which, a2m(r-pa-pu), was recovered as a derivative of the a2m(1 1511) allele. The behavior and composition of this allele is described. In the presence of the independently inherited regulatory element, En, the a2m(r-pa-pu) allele mutates and expresses in the aleurone purple, pale and colorless sectors within a colorless background. In the absence of En, the pigmentation is uniformly pale. Colored and colorless germinal mutations of the a2m(r-pa-pu) allele were recovered, although the derivative alleles tested did not respond to En. Uniformly colored derivatives, designated A2', arise only from states of a2m(r-pa-pu) that respond to an active En at relatively early stages in plant development, suggesting that somatic and germinal mutations may arise through similar events. Mutations to A2-expressing alleles appear to occur relatively late in plant development, that is, at or near meiosis, since recognizable mutant sectors do not appear on testcross ears. Kernels exhibiting such mutants are randomly distributed over the ear. The resulting A2' alleles express pigmentation ranging in a continual sequential series from dark pale to intense purple.