The importance of climatic factors and outliers in predicting regional monthly campylobacteriosis risk in Georgia, USA.

Incidence of Campylobacter infection exhibits a strong seasonal component and regional variations in temperate climate zones. Forecasting the risk of infection regionally may provide clues to identify sources of transmission affected by temperature and precipitation. The objectives of this study were to (1) assess temporal patterns and differences in campylobacteriosis risk among nine climatic divisions of Georgia, USA, (2) compare univariate forecasting models that analyze campylobacteriosis risk over time with those that incorporate temperature and/or precipitation, and (3) investigate alternatives to supposedly random walk series and non-random occurrences that could be outliers. Temporal patterns of campylobacteriosis risk in Georgia were visually and statistically assessed. Univariate and multivariable forecasting models were used to predict the risk of campylobacteriosis and the coefficient of determination (R(2)) was used for evaluating training (1999-2007) and holdout (2008) samples. Statistical control charting and rolling holdout periods were investigated to better understand the effect of outliers and improve forecasts. State and division level campylobacteriosis risk exhibited seasonal patterns with peaks occurring between June and August, and there were significant associations between campylobacteriosis risk, precipitation, and temperature. State and combined division forecasts were better than divisions alone, and models that included climate variables were comparable to univariate models. While rolling holdout techniques did not improve predictive ability, control charting identified high-risk time periods that require further investigation. These findings are important in (1) determining how climatic factors affect environmental sources and reservoirs of Campylobacter spp. and (2) identifying regional spikes in the risk of human Campylobacter infection and their underlying causes.

Appropriateness of blood product transfusion in the Obstetrics and Gynaecology (O&G) department of a tertiary hospital in West Africa.

BACKGROUND: Misuse of blood by clinicians was suggested to explain blood shortage in sub-Saharan Africa although based on little evidence. This study evaluated whether routine halving (restricted) of blood requests was justified. STUDY DESIGN AND METHODS: On alternated days for 3 months in 2011-2012, restricted or full blood product supply [whole blood (WB), red cell concentrate (RCC)] was provided to the Obstetrics & Gynaecology department (O&G). Patient age, haemoglobin (Hb) level pre- and post-transfusion, clinical condition, blood products request and supply, transfused and returned, clinical outcome were collated. RESULTS: Five hundred and nineteen patients (249 restricted and 270 full supply) received 1001 blood products (94.6% WB, 6.4% RCC). Clinical conditions were severe peri-partum bleeding (72.4%) requiring emergency transfusion (82%) whilst 27.6% of total transfusion was for anaemia, 18% being moderate (8-10 g dL(-1) ). Pre-transfusion Hb level was <6 g dL(-1) in 36.7%, 6-8 g dL(-1) 29.1% and ≥ 8 g dL(-1) in 33.2% of cases. Fifty-five percent of the transfused blood was stored ≤ 1 week. Restricted supply triggered additional request (40%) compared to 10% in full supply mode. Whether with restricted or full supply, blood requests, supply and units transfused/patient were similar (restricted 2.3 and 2.1 unit patient(-1) and full 2.9 and 2.3 unit patient(-1) , respectively). Fatal clinical outcome was 3.1% evenly distributed between supply modes and transfusion reactions 0.8%. CONCLUSIONS: O&G clinicians order blood according to clinical need and transfuse 85% of the products supplied. Product supply did not significantly affect use although appropriateness of transfusion was difficult to assess.

Environmental variables serve as predictors of the invasive Asian longhorned tick (Haemaphysalis longicornis Neumann): An approach for targeted tick surveillance.

Since the 2017 discovery of established populations of the Asian longhorned tick, (Haemaphysalis longicornis Neumann) in the United States, populations continue to be detected in new areas. For this exotic and invasive species, capable of transmitting a diverse repertoire of pathogens and blood feeding on a variety of host species, there remains a lack of targeted information on how to best prepare for this tick and understand when and where it occurs. To fill this gap, we conducted two years of weekly tick surveillance at four farms in Tennessee (three H. longicornis-infested and one without) to identify environmental factors associated with each questing life stage, to investigate predictors of abundance, and to determine the likelihood of not collecting ticks at different life stages. A total of 46,770 ticks were collected, of which 12,607 H. longicornis and five other tick species were identified. Overall, abundance of H. longicornis were associated with spring and summer seasons, forested environments, relative humidity and barometric pressure, sunny conditions, and in relation with other tick species. The likelihood of not collecting H. longicornis was associated with day length and barometric pressure. Additional associations for different life stages were also identified and included other tick species, climatic variables, and environmental conditions. Here, we demonstrated that environmental variables can be useful to predict the presence of questing H. longicornis and provide ideas on how to use this information to develop a surveillance plan for different southeastern areas with and without infestations.

Neural and humoral changes associated with the adjustable gastric band: insights from a rodent model.

BACKGROUND: Bariatric surgical procedures, including the laparoscopic adjustable gastric band (LAGB), are currently the only effective treatments for morbid obesity, however, there is no clear understanding of the mechanisms underpinning the efficacy of LAGB. The aim of this study is to examine changes in activation of the sensory neuronal pathways and levels of circulating gut hormones associated with inflation of an AGB. DESIGN AND RESULTS: The trajectory within the central nervous system of polysynaptic projections of sensory neurons innervating the stomach was determined using the transsynaptically transported herpes simplex virus (HSV). Populations of HSV-infected neurons were present in the brainstem, hypothalamus and cortical regions associated with energy balance. An elevation of Fos protein was present within the nucleus of the solitary tract, a region of the brainstem involved in the control of food intake, following acute and chronic band inflation. Two approaches were used to test (1) the impact of inflation of the band alone (on a standard caloric background) or (2) the impact of a standard caloric meal (on the background of the inflated band) on circulating gut hormones. Importantly, there was a significant elevation of glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) following oral gavage of a liquid meal in animals with pre-inflated bands. There was no impact of inflation of the band alone on circulating GLP-1, PYY or ghrelin in animals on a standard caloric background. CONCLUSION: These data are consistent with the notion that the LAGB exerts its effects on satiety, reduced food intake and reduced body weight by the modulation of both neural and hormonal responses with the latter involving an elevation of meal-related levels of GLP-1 and PYY. These data are contrary to the view that the surgery is purely 'restrictive'.

Comparison of three time-series models for predicting campylobacteriosis risk.

Three time-series models (regression, decomposition, and Box-Jenkins autoregressive integrated moving averages) were applied to national surveillance data for campylobacteriosis with the goal of disease forecasting in three US states. Datasets spanned 1998-2007 for Minnesota and Oregon, and 1999-2007 for Georgia. Year 2008 was used to validate model results. Mean absolute percent error, mean square error and coefficient of determination (R2) were the main evaluation fit statistics. Results showed that decomposition best captured the temporal patterns in disease risk. Training dataset R2 values were 72.2%, 76.3% and 89.9% and validation year R2 values were 66.2%, 52.6% and 79.9% respectively for Georgia, Oregon and Minnesota. All three techniques could be utilized to predict monthly risk of infection for Campylobacter sp. However, the decomposition model provided the fastest, most accurate, user-friendly method. Use of this model can assist public health personnel in predicting epidemics and developing disease intervention strategies.

Spatial-temporal clusters of host-seeking Aedes albopictus, Aedes japonicus, and Aedes triseriatus collections in a La Crosse virus endemic county (Knox County, Tennessee, USA).

A bite from a La Crosse virus (LACV) infected Aedes mosquito can cause La Crosse encephalitis (LACE), which is a neuro-invasive disease that disproportionately affects children under the age of 16 in Southern Appalachia. The three vectors for LACV are Aedes albopictus (Skuse), Ae. japonicus (Theobald), and Ae. triseriatus (Say). Localized maps of the geographic distribution of vectors are practical tools for mosquito management personnel to target areas with high mosquito abundance. This study hypothesized that LACV vectors have unique species-specific spatial and temporal clusters. To test this, 44 sites were identified in Knox County, Tennessee for their land use/type. At each site, host-seeking mosquitoes were collected approximately every other week from May-October 2018. Spatial clusters of host-seeking mosquito collections for each of the three mosquito species were investigated using Kulldorff's spatial scan statistic, specifying a retrospective space-time Bernoulli model. Most vector clusters were identified in south-central Knox County while the seasonality of clusters varied by mosquito species. Clusters of Ae. albopictus were observed throughout the entire study period while clusters of Ae. japonicus and Ae. triseriatus only occurred May-June. The findings indicate that the relative abundance of LACV vectors were more abundant in south-central Knox County compared to the rest of the county. Of interest, these clusters spatially overlapped with previous LACE diagnosed cases. These findings are useful in guiding decisions on targeted mosquito control in Knox County and may be applied to other counties within Southern Appalachia.

Advanced alveolar rhabdomyosarcoma of the uterus: a case report.

Alveolar rhabdomyosarcoma is an uncommon malignant soft tissue tumour rarely found in the female genital tract and carries a very poor prognosis especially in adults. A 44 year old premenopausal woman was evaluated for a lower abdominal mass, intermittent unprovoked vaginal bleeding and weight loss. Examination showed a huge abdomino-pelvic mass, and an irregular cauliflower mass protruding from the cervix, from which a biopsy was taken. Exploratory laparotomy revealed a widespread disseminated uterine tumour with an "omental cake" and involving virtually all the abdominal viscera. Debulking surgery was found to be non-beneficial and uterine and omental biopsies were taken. The cervical, uterine and omental biopsies were all diagnosed alveolar rhabdomyosarcoma. Neither chemotherapy nor radiotherapy could be started before the client died of fulminant neoplastic dissemination 17 days postoperatively. While the optimal management of this rare tumour is unknown, early recognition and diagnosis, and a prompt multimodality treatment approach of surgery, chemotherapy and radiotherapy offers the best chance of cure.

Retrospective analysis of local injection site adverse reactions associated with 230 allogenic administrations of bone marrow-derived mesenchymal stem cells in 164 horses.

BACKGROUND: Bone marrow-derived mesenchymal stem cells (BM-MSCs) are frequently used in the treatment of musculoskeletal injuries. Fully characterised cells that are readily available for use is optimum. Allogenic BM-MSCs can satisfy the need for rapid treatment, however, their safety has been questioned. OBJECTIVES: Objectives were to characterise BM-MSCs from an adult donor horse, in vitro, and to identify and describe adverse reactions that occurred following their injection into other horses. We hypothesised that BM-MSCs capable of proliferation, differentiation and lacking MHC II from one donor could be implanted into another individual without significant adverse reactions and the frequency of adverse reactions in clinical cases would be similar to that previously reported for autologous BM-MSCs. STUDY DESIGN: Retrospective clinical study. METHODS: BM-MSCs were proliferated and characterised from one donor and cryopreserved for clinical use. Medical records for horses injected with allogenic BM-MSCs from this donor at a single hospital were used. After routine lameness exam, lesions were identified using diagnostic ultrasound or MRI. Post injection reaction was defined as increased pain, swelling, or heat at or near injection site, or increased lameness. Treatments required for each reaction were noted. RESULTS: BM-MSCs proliferated and underwent differentiation. Cells were found to be negative for MHC-II (<2%) and were viable after cryopreservation and shipping. Ten of 230 (4.35%) injections were noted to be associated with an adverse reaction. Adverse reactions occurred in synovial structures (n = 3) and in soft tissues (n = 7). MAIN LIMITATIONS: This investigation could underestimate the number and severity of reactions. Mild reactions, such as synovitis, may have been missed. Also, anti-inflammatory drugs could overshadow mild reactions, making them less likely to be detected. CONCLUSIONS: Fully characterised allogenic BM-MSCs originating from a single donor horse can be administered to horses with soft tissue injuries with a low rate of adverse reaction. The Summary is available in Portuguese - see Supporting Information.

Feeding practices and effects of gastrointestinal parasite infections on live weight gain of small ruminants in smallholder mixed farms in Kenya.

The objective of this study was to quantify the effects of gastrointestinal nematodosis on live weight gain (LWG) of sheep and goats kept in smallholder farms in Kenya. A total of 307 sheep and goats from smallholder farms were sampled using a 2-stage cluster and systematic random approach. Sampled farms were visited once a month for nine months during which a health and production survey questionnaire was administered, animals weighed and fecal samples taken for fecal egg count. Descriptive statistics and a generalized linear mixed model were performed in SAS. The mean LWG of suckling kids and lambs was low (mean=46 g/day). High fecal egg count and lack of feed supplementation were identified as the main factors limiting growth. Improved helminth control and nutrition are required to optimize production.

Spontaneous heterotopic pregnancy with live infant: report of two cases.

Heterotopic pregnancy is a potentially fatal condition that rarely occurs in natural conception cycles. We report two cases diagnosed within one month in a 20 year old gravida 3, para 0+2 without any known risk factor and a 38 year old gravida 12, para 6+5 with risk factors. The ectopic pregnancies were diagnosed after rupturing at 10 and 17 weeks respectively and resected via laparotomies. The courses of the intrauterine pregnancies were uneventful and both clients delivered vaginally at term. Heterotopic pregnancy is an important differential diagnosis to consider in clients with intrauterine pregnancies presenting with acute abdominal pain and haemoperitoneum.

Habitat and Vegetation Variables Are Not Enough When Predicting Tick Populations in the Southeastern United States.

Two tick-borne diseases with expanding case and vector distributions are ehrlichiosis (transmitted by Amblyomma americanum) and rickettiosis (transmitted by A. maculatum and Dermacentor variabilis). There is a critical need to identify the specific habitats where each of these species is likely to be encountered to classify and pinpoint risk areas. Consequently, an in-depth tick prevalence study was conducted on the dominant ticks in the southeast. Vegetation, soil, and remote sensing data were used to test the hypothesis that habitat and vegetation variables can predict tick abundances. No variables were significant predictors of A. americanum adult and nymph tick abundance, and no clustering was evident because this species was found throughout the study area. For A. maculatum adult tick abundance was predicted by NDVI and by the interaction between habitat type and plant diversity; two significant population clusters were identified in a heterogeneous area suitable for quail habitat. For D. variabilis no environmental variables were significant predictors of adult abundance; however, D. variabilis collections clustered in three significant areas best described as agriculture areas with defined edges. This study identified few landscape and vegetation variables associated with tick presence. While some variables were significantly associated with tick populations, the amount of explained variation was not useful for predicting reliably where ticks occur; consequently, additional research that includes multiple sampling seasons and locations throughout the southeast are warranted. This low amount of explained variation may also be due to the use of hosts for dispersal, and potentially to other abiotic and biotic variables. Host species play a large role in the establishment, maintenance, and dispersal of a tick species, as well as the maintenance of disease cycles, dispersal to new areas, and identification of risk areas.

Isolation of thogoto virus (Orthomyxoviridae) from the banded mongoose, Mongos mungo (Herpestidae), in Uganda.

Small wild vertebrates were trapped during an investigation into possible vertebrate reservoirs of o'nyong-nyong (ONN) fever virus in Uganda in 1997. Antibody neutralization test results and virus isolation attempts were negative for ONN virus, confirming the work of earlier investigators, who also failed to find evidence for a nonhuman ONN virus reservoir. In the course of these ONN virus studies, Thogoto virus was isolated from one of eight banded mongooses (Mongos mungo). This is the first isolation of Thogoto virus from a wild vertebrate. Neutralizing antibodies to Thogoto virus were also found in two of the other mongooses.

In vitro analysis of equine, bone marrow-derived mesenchymal stem cells demonstrates differences within age- and gender-matched horses.

REASONS FOR PERFORMING THE STUDY: Stem cell therapies are used routinely in equine practice. Most published reports characterise stem cells derived from younger horses; however, middle-aged horses are often in athletic performance, and experience degenerative medical conditions. Thus, mesenchymal stem cells (MSCs) from this group should be investigated. OBJECTIVE: To describe differences in in vitro adherence, proliferation and potential for differentiation of equine bone marrow-derived MSCs (equine BMMSCs) harvested from middle-aged (10-13 years old) female donors. STUDY DESIGN: Descriptive study of stem cell characteristics. METHODS: Equine BMMSCs from 6 horses were cultured in vitro and evaluated for viability, proliferation, osteogenesis, chondrogenesis, adipogenesis, cluster-of-differentiation markers and gene expression. RESULTS: Equine BMMSCs from all 6 donors demonstrated fibroblastic, cellular morphology, adherence to plastic and expression of cluster-of-differentiation markers. They varied in their rate of proliferation and trilineage differentiation. The equine BMMSCs of one of 6 donors demonstrated a higher rate of proliferation, enhanced ability for cell passaging and a more robust in vitro differentiation. Comparatively, equine BMMSCs from 2 donors demonstrated a lower rate of proliferation and lack of osteogenic and chondrogenic differentiation. CONCLUSION: The results of this study confirm that donor-to-donor variation in equine BMMSCs exists and this variation can be documented using in vitro assays. Subjective assessment suggests that the rate of proliferation tends to correlate with differentiation potential.

Prescribing practices for malaria in a rural Ugandan hospital: evaluation of a new malaria treatment policy.

BACKGROUND: Increasing resistance to first line antimalarial drugs led to a change in the antimalarial policy of Uganda in 2005. Successful implementation of this policy depends on changing prescribing patterns of health workers. OBJECTIVES: To describe prescribing patterns for malaria and associated factors in a rural Ugandan hospital following a change in antimalarial treatment policy from chloroquine plus sulphadoxine-pyrimethamine to artemisinin-based combination therapies. METHODS: From the outpatients register, 715 prescriptions for malaria were reviewed. Data was collected on patient demographics, prescriber factors and prescription patterns. Prescriptions were considered to conform to the new antimalarial policy if artemether-lumefantrine was prescribed for uncomplicated malaria or quinine for treatment failure or complicated malaria. RESULTS: The most frequently prescribed antimalarials for uncomplicated and complicated malaria were artemetherlumefantrine (n=564, 88.5%) and quinine (n=66, 84.6%) respectively. The proportion of prescriptions conforming to the new antimalarial treatment policy was 88.1% (n=630). Predictors of conformity were: duration in service of less than 6 years (OR=3.40. CI=1.24-9.33), prescriber's profession (OR=97.51, CI=27.29-348.34) and diagnosis of uncomplicated malaria (OR=10.13, CI=3.37-30.42). CONCLUSIONS: Adequate training and provision of information relevant to the needs of different cadres of health workers is needed to promote effective uptake of new treatment policies.

Vulvar lipoma: is it so rare?

Vulvar lipoma is said to be so rare that only a few cases have been reported. We present two cases of vulvar lipoma that were diagnosed within six months in our centre in a 28 year-old para 2 and 35 year-old para 1 woman both of whom presented with slow-growing masses in the vulva. A detailed discussion of the clinical features and current management options are outlined, with emphasis on the need to subject all excised lesions to histopathological evaluation; to ensure accurate diagnosis and differentiate this benign swelling from cystic swellings and malignant neoplasms in the vulva.

Determinants of the geographical distribution of endemic giardiasis in Ontario, Canada: a spatial modelling approach.

Giardiasis surveillance data as well as drinking water, socioeconomic and land-use data were used in spatial regression models to investigate determinants of the geographic distribution of endemic giardiasis in southern Ontario. Higher giardiasis rates were observed in areas using surface water [rate ratio (RR) 2.36, 95 % CI 1.38-4.05] and in rural areas (RR 1.79, 95 % CI 1.32-2.37). Lower rates were observed in areas using filtered water (RR 0.55, 95 % CI 0.42-0.94) and in those with high median income (RR 0.62, 95 % CI 0.42-0.92). Chlorination of drinking water, cattle density and intensity of manure application on farmland were not significant determinants. The study shows that waterborne transmission plays an important role in giardiasis distribution in southern Ontario and that well-collected routine surveillance data could be useful for investigation of disease determinants and identification of high-risk communities. This information is useful in guiding decisions on control strategies.

Transvaginal sacrospinous colpopexy: anatomic landmarks to be aware of to minimize complications.

Transvaginal sacrospinous colpopexy is currently used to repair varying degrees of vaginal vault prolapse. It involves placing a stitch from the vaginal cuff to the sacrospinous ligament approximately 2 cm medial to the ischial spine to correct the defect. This may be associated with pudendal artery and nerve (pudendal complex) along with sciatic nerve injury if the procedure is not carefully performed. This study was designed to emphasize the anatomic landmarks that make the sacrospinous ligament a potentially dangerous zone that surgeons must be aware of to minimize complications. Twenty-four female cadavers were obtained from the Louisiana State University Medical School anatomy laboratory. They were carefully dissected to expose the anatomic structures of interest. The following measurements were then obtained: the distance from the ischial spine to the medial border of the sacrum, the medial and lateral aspects of the pudendal complex, and the sciatic nerve. The obstetric conjugate of the pelves was also obtained. The pudendal complex and sciatic nerve were found to be 0.90 to 3.30 cm medial to the ischial spine. After the six smallest and largest pelves were compared, it was noted that the larger the obstetric conjugate the longer the sacrospinous ligament and vice versa. Also, the distance from the ischial spine to the sciatic nerve correlated with the size of the obstetric conjugate. The pudendal complex and sciatic nerve travel underneath the lateral third of the sacrospinous ligament. Therefore we recommend that the placement of the stitch be made medial to that portion of the ligament. More importantly, the stitch must be placed as superficial as possible and never across the entire thickness of the sacropinous ligament. This should decrease the rate of complications associated with this type of colpopexy.

Identification of a new subgroup of SIVagm in tantalus monkeys.

Simian immunodeficiency viruses from African green monkeys (SIVagm) can be classified into three subgroups based upon the species from which they were isolated. The most extensively studied subgroup are composed of SIVagm isolated from vervet monkeys (Cercopithicus pygerythrus). Fewer isolates have been characterized from either grivets (Cercopithicus aethiops) or green monkeys (Cercopithicus sabeus). An additional distinct species of African green monkeys, tantalus monkeys (Cercopithicus tantalus), has not been characterized in terms of SIV infection. A high seroprevalence of SIV-specific antibodies was identified in sera collected from Ugandan tantalus monkeys. SIV was isolated from PBMC (SIVagm/tan), the gag region amplified by polymerase chain reaction, cloned, and sequenced. Based upon gag, SIVagm/tan isolates cluster genetically with other previously recognized SIVagm strains. However, SIVagm from tantalus monkeys forms a distinct genetic subgroup. These data confirm earlier observations of species-specific subtypes of SIVagm viruses and support the hypothesis that these viruses may have coevolved with their host during geographic dispersion throughout Africa.