Travel-associated Legionnaires' disease: would changing cluster definition lead to the prevention of a larger number of cases?

According to European Guidelines for Legionnaires' Disease prevention and control, travel-associated Legionnaires' disease (TALD) cases are managed differently if classified as sporadic or as part of a cluster and more stringent control measures are deployed after clusters are identified. In this study, we propose to modify the current cluster definition: 'two or more cases of Legionnaires' disease (LD) who stayed at, or visited, the same commercial accommodation site 2-10 days before onset of illness and whose onset is within the same 2-year period' with a new cluster definition, i.e. accommodation sites associated with multiple cases regardless of the time elapsed between them. TALD cases occurred in Italy and in the Balearic Islands between 2005 and 2015 were analysed applying the current European Legionnaires' Disease Surveillance Network (ELDSNet) cluster definition. In a sample of selected accommodation sites with multiple cases, a microbiological study was also conducted. Using the new definition, 63 additional sites (16.4% increase) and 225 additional linked cases (19.5% increase) were identified. Legionella pneumophila sg1 was isolated from 90.7% of the selected accommodation sites. The use of the here proposed TALD cluster definition would warrant a full investigation for each new identified case. This approach should therefore increase the number of sites that will require a risk assessment and, in the presence of an increased risk, the adoption of LD control measures to hopefully prevent additional cases.

Inhibition of Listeria monocytogenes biofilms by bacteriocin-producing bacteria isolated from mushroom substrate.

AIMS: This study was designed to investigate the ability of naturally occurring bacteria isolated from mushroom substrate to prevent biofilm formation by Listeria monocytogenes or to remove existing biofilms in mushroom production facilities. METHODS AND RESULTS: It is generally recognized that L. monocytogenes forms biofilms that can facilitate its survival in food-processing environments. Eleven bacteriocin-producing isolates were identified and the bacteriocins characterized based on heat and enzyme inactivation studies. Further characterization was undertaken by MALDI-TOF mass spectrometry, PCR and sequencing. Production of nisin Z (by Lactococcus lactis isolates), subtilomycin (by Bacillus subtilis isolates) and lichenicidin (by Bacillus licheniformis and Bacillus sonorensis isolates) was detected. In co-culture with L. monocytogenes, the bacteriocin-producing strains could prevent biofilm formation and reduce pre-formed biofilms. CONCLUSIONS: Mushroom substrate can be a source of bacteriocin-producing bacteria that can antagonize L. monocytogenes. SIGNIFICANCE AND IMPACT OF THE STUDY: The results highlight the potential of bacteriocin-producing strains from mushroom substrate to reduce L. monocytogenes biofilm in food production environments, contributing to a reduction in the risk of food contamination from the environment.

Optical beam deflection sensor: design and experiments.

In this work, we present a double-pass optical beam deflection sensor and its optical design method. To accomplish that, a mathematical model was proposed and computational simulations were performed, in order to obtain the sensor's characteristic curves and to analyze its behavior as function of design parameters. The mathematical model was validated by comparison with the characteristic curves acquired experimentally. The sensor was employed to detect acoustic pulses generated by a pulsed laser in a sample surface, in order to show its potential for monitoring applications handling high energy input as laser welding or laser ablation.

Solar radiation and water vapor pressure to forecast chickenpox epidemics.

The clear seasonality of varicella infections in temperate regions suggests the influence of meteorologic conditions. However, there are very few data on this association. The aim of this study was to determine the seasonal pattern of varicella infections on the Mediterranean island of Mallorca (Spain), and its association with meteorologic conditions and schooling. Data on the number of cases of varicella were obtained from the Network of Epidemiologic Surveillance, which is composed of primary care physicians who notify varicella cases on a compulsory basis. From 1995 to 2012, varicella cases were correlated to temperature, humidity, rainfall, water vapor pressure, atmospheric pressure, wind speed, and solar radiation using regression and time-series models. The influence of schooling was also analyzed. A total of 68,379 cases of varicella were notified during the study period. Cases occurred all year round, with a peak incidence in June. Varicella cases increased with the decrease in water vapor pressure and/or the increase of solar radiation, 3 and 4 weeks prior to reporting, respectively. An inverse association was also observed between varicella cases and school holidays. Using these variables, the best fitting autoregressive moving average with exogenous variables (ARMAX) model could predict 95 % of varicella cases. In conclusion, varicella in our region had a clear seasonality, which was mainly determined by solar radiation and water vapor pressure.

Scattered light imaging method (SLIM) for characterization of arbitrary laser beam intensity profiles.

A laser beam characterization method is reported, which is applicable to arbitrary and ideal laser beam intensity profiles. This method, called the scattered light imaging method (SLIM), is based on scattered light imaging of a laser beam and provides a complete visualization of it in the region of interest. The method was applied to characterize an arbitrary pedestal-shaped beam and compared with a conventional method (camera scanning). The results we presented show that, for arbitrary beams, it seems much more meaningful to know the intensity profile evolution than to determine an M2 value. Therefore the SLIM is a powerful tool for a new and more complete type of laser beam characterization.

Quality of life after laparoscopic fundoplication for gastroesophageal reflux disease. Preliminary study.

Laparoscopic fundoplication (LF) is the treatment of choice for gastroesophageal reflux disease (GERD).Our paper evaluates post LF quality of life (QL). Patients treated between January 2008 and May 2011 by the same surgeon were asked to fill in the Velanovich questionnaires for Gastro - Oesophageal Reflux Disease - Health Related Quality of Life (GERD-HRQL). The 10 questions were designed to assess GERD specific symptoms prior to (part A) and after surgery (part B). The Velanovich score is 0 if the patient is asymptomatic and 50 if the symptoms are at maximum intensity. Only 32 out of the 54 patients operated during the study filled in the questionnaire:28 patients (87.5%) had hiatus hernia (HH), 16 cases were associated with reflux erosive esophagitis (EE), 4 patients had non-erosive reflux disease (NERD) and one had Barrett's esophagus (BE). We used Toupet partial posterior fund oplication for 12 patients and Nissen total fundoplication for 20 patients. The short gastric vessels were divided in all patients.The female - male ratio was 21:11 with a mean age of 55.13 years and the mean follow up period for questionnaire B was of25.2 months. The Velanovich A score was 29.9 Â+-10.9, and the follow up B score was 3.4Â+-2.4 (CI (95%) 22.9-39.9; p 0.05).There were no B score statistical differences between sex ratio(3.9 vs 2.4) and type of fundoplication (Nissen 3.2 vs Toupet4.1). 29 patients (90.62%) declared that their QL improved after surgery. The main indication for surgery present in almost every patient included in this study was the presence of theHH and RE. LF improved the quality of life of patients with GERD. There were no statistical differences of the Velanovich score according to GERD stage (EE, NERD with or without HH), sex ratio and type of LF, Toupet or Nissen.

[Perforation of hollow organs in the abdominal contusion: diagnostic features and prognostic factors of death]. / Perforatiile organelor cavitare prin contuzie abdominala: particularitati diagnostice si factori prognostici de deces.

UNLABELLED: Blunt hollow viscus perforations (HVP) due to abdominal contusions (AC), although rare, are difficult to diagnose early and are associated with a high mortality. MATERIALS AND METHODS: Our paper analyses retrospectively data from patients operated for HVP between January 2005 and January 2009, the efficiency of different diagnostic tools, mortality and prognostic factors for death. RESULTS: There were 62 patients operated for HVP, 14 of which had isolated abdominal contusion and 48 were poly trauma patients. There were 9 women and 53 men, the mean age was 41.5 years (SD: +17,9), the mean ISS was 32.94 (SD: +15,94), 23 patients had associated solid viscus injuries (SVI). Clinical examination was irelevant for 16 of the 62 patients, abdominal Xray was false negative for 30 out of 35 patients and abdominal ultrasound was false negative for 16 out of 60 patients. Abdominal CT was initially false negative for 7 out of 38 patients: for 4 of them the abdominal CT was repeated and was positive for HVP, for 3 patients a diagnostic laparoscopy was performed. Direct signs for HVP on abdominal CT were present for 3 out of 38 patients. Diagnostic laparoscopy was performed for 7 patients with suspicion for HVP, and was positive for 6 of them and false negative for a patient with a duodenal perforation. Single organ perforations were present in 55 cases, multi organ perforations were present in 7 cases. There were 15 deaths (15.2%), most of them caused by haemodynamic instability (3 out of 6 patients) and associated lesions: SOL for 9 out of 23 cases, pelvic fracture (PF) for 6 out of 14 patients, craniocerebral trauma (CCT) for 12 out of 33 patients.Multivariate analysis showed that the prognostic factors for death were ISS value (p = 0,023) and associated CCT (odds ratio = 4,95; p = 0,017). The following factors were not confirmed as prognostic factors for death: age, haemodynamic instability, associated SVI, thoracic trauma (TT), pelvic fractures (PF), limbs fractures (LF) and admission-operation interval under 6 hours. CONCLUSIONS: Hollow viscus perforations due to abdominal contusions have a high mortality, early diagnosis is difficult, repeated abdominal CT and the selective use of diagnostic laparoscopy for haemodynamic stable patients with ambiguous clinical examination and diagnostic imaging are salutary. Prognostic factors for death were the ISS value and associated craniocerebral trauma.

The effect of bovine milk lactoferrin on human breast cancer cell lines.

The evidence that biologically active food components are key environmental factors affecting the incidence of many chronic diseases is overwhelming. However, the full extent of such components in our diet is unknown, as is our understanding of their mechanisms of action. Beyond the interaction of these food components with the gut and intestinal immune functions, whey proteins such as lactoferrin are being tested as anticancer agents. Lactoferrin is an iron-binding protein that has been reported to inhibit several types of cancer. In the present work, the effects of bovine milk lactoferrin on human breast cancer HS578T and T47D cells were studied. The cells were either untreated or treated with lactoferrin concentrations ranging from 0.125 to 125 µM. Lactoferrin decreased the cell viability of HS578T and T47D by 47 and 54%, respectively, and increased apoptosis about 2-fold for both cell lines. Proliferation rates decreased by 40.3 and 63.9% for HS578T and T47D, respectively. For the T47D line, cell migration decreased in the presence of the protein. Although the mechanisms of action are not fully known, the results gathered in this work suggest that lactoferrin interferes with some of the most important steps involved in cancer development.

Is laparoscopy still needed in blunt abdominal trauma?

INTRODUCTION: Laparoscopy, as a minimally invasive diagnostic and therapeutic tool in blunt abdominal trauma (BAT), is not commonly used and has been shown to be controversial. The aim of this study is to assess the role of laparoscopy in the diagnosis and therapy of BAT. METHODS: A systematic review and a comprehensive literature search was performed at the U.S. National Library of Medicine site in Medline and PubMed from January 2000 to 31 December 2007. This article attempts to outline the efficacy, the indications, contraindications, surgical technique and therapeutic possibilities of laparoscopy in BAT. Pediatric surgery articles and those addressing penetrating abdominal wounds, nontraumatic abdominal emergencies and iatrogenic injuries were excluded from this review. RESULTS: Sixty-six articles were reviewed, which included 22 case studies, 27 case reports, 17 reviews and 2 guidelines. The reviewed articles comprised 343 patients with BAT and laparoscopic approach. Therapeutic laparoscopy was possible in 168 cases (48.98%), 51 cases were converted (14.87%), overlooked injuries were absent, 6 patients had complications (1.75%), no mortality laparoscopy-related. The main indications for laparoscopy in BAT include the confirmation of suspected diaphragmatic defects, suspected hollow viscus and mesenteric injuries, in patients with inconclusive clinical exams and abdominal imaging. Diagnostic laparoscopy (DL) is also indicated in patients with suspected intra-abdominal injuries when advanced emergency imaging investigations are unavailable. Laparoscopy allows the surgeon to perform hemostasis, resections, suturing, autotransfusion, etc. CONCLUSION: Although is not widely used, laparoscopy could still be useful in selected patients with BAT who have equivocal findings on clinical exam a nd imaging investigations in order to clarify the lesional diagnosis, thus avoiding unnecessary laparotomies. Multicenter prospective studies are needed to better assess the role of laparoscopy in blunt abdominal trauma.

[Temporary loop-ileostomy for distal anastomosis protection in colorectal resections]. / Ileostomia temporara pentru protectia anastomozelor în rezectiile colonice si rectale.

Temporary loop-ileostomy (TLI) is an efficient modality to protect distal anastomosis in colorectal resections. TLI reduces the consequences of distal anastomosis leakage. We present the technique of construction and closure of TLI, the indications, postoperative complications and personal experience in early closure.

Selection and characterization of a multivalent Salmonella phage and its production in a nonpathogenic Escherichia coli strain.

We report the selection and amplification of the broad-host-range Salmonella phage phi PVP-SE1 in an alternative nonpathogenic host. The lytic spectrum and the phage DNA restriction profile were not modified upon replication in Escherichia coli Bl21, suggesting the possibility of producing this phage in a nonpathogenic host, contributing to the safety and easier approval of a product based on this Salmonella biocontrol agent.

Method for bacteriophage isolation against target Campylobacter strains.

AIMS: Poultry meat is considered a major source of Campylobacter. This micro-aerobic bacterium is commonly responsible for foodborne illness. This work focuses on the isolation of Campylobacter coli lytic bacteriophages (phages) against target C. coli strains. METHODS AND RESULTS: A method involving the enrichment of free-range chicken samples in a broth containing the target C. coli strains and salts (CaCl(2) and MgSO(4)) was used for phage isolation. This method allowed the isolation of 43 phages that were active against 83% of the C. coli strains used in the isolation procedure. Approximately 65% of the phages were also effective against Campylobacter jejuni strains. CONCLUSIONS: The use of target pathogens in the phage isolation step improves the likelihood of detecting and isolating phages for the control of these specific strains. SIGNIFICANCE AND IMPACT OF THE STUDY: This technique will be valuable in the context of phage therapy for enriching for phages that are active against specifically identified strains of bacteria, for example from a food poisoning outbreak or epidemic strains resistant to multiple antibiotics. In these situations, using the conventional methods for searching for bacteriophages active for these particular strains can be a time-consuming, if not an unsuccessful process. Using the isolation method described in this manuscript, the particular strains can be added to the enrichment broth increasing the probability of finding phages against them. Therefore, it will shorten the time needed for seeking phages able to lyse target strains, which in most of the cases, because of the rapid increase in antimicrobial-resistant bacteria, is of crucial importance.

[Laparoscopic repair of abdominal ventral hernias]. / Tehnica abordului laparoscopic al defectelor parietale abdominale ventrale mediane.

This paper presents the surgical technique for ventral abdominal hernia repair, including median incisional hernia, umbilical hernia and epigastric hernia. The main stages of the surgical procedure are as follows: pinpointing the parietal defect, insufflation of pneumoperitoneum and placing the trocars, inspection and adhesiolysis of the peritoneal cavity, closure of the defect with extracorporeal transparietal U reverse stitches, preparing the mesh, introducing the mesh in the peritoneal cavity and fixing it with transfascial sutures and tackers. Postop care measures, postop complications and controversies regarding mesh composition and fixation method are also discussed.

[Laparoscopic modified partial posterior Toupet fundoplication]. / Tehnica fundoplicaturii partiale posterioare Toupet modificata.

We describe the technique of the laparoscopic posterior partial fundoplication used by us for the treatment of gastroesophageal reflux disease. We use the division of short gastric vessels for the mobilisation of the gastric fundus in addition to the Toupet partial posterior fundoplication modified by Coster. The fundoplication is achived with only 5 stiches, 3 for the right hemivalve and 2 for the left one. We also present the advantages, the indications, the contraindications and the main complications of the procedure.

[Conversion in laparoscopic cholecystectomy for acute cholecystitis]. / Conversia în colecistita acuta abordata laparoscopic.

INTRODUCTION: By definition, conversion means giving up laparoscopic surgery and continuing the operation with open, conventional surgery no matter the reason, nor the moment of the operation. PURPOSE: To evaluate the causes and the moment of conversion, the technique used to perform the cholecystectomy after conversion, analysing the experience of the surgical team in deciding the moment of conversion. METHOD: A retrospective study performed on patients which underwent a laparoscopic operation for acute cholecystitis between January 1st 2004 - December 31st 2007. Clinical examination, biological parameters, surgical proceedings, histopathological examination of the pieces removed and the patient's postoperative evolution were analysed. FINDINGS: There were performed 1522 laparoscopic cholecystectomies for acute cholecystitis, out of which 108 (7.1% of all) were converted to open surgery. Analysing the experience of the surgical team, we can say that the converted laparoscopic cholecystectomies are found mainly in teams formed by senior surgeons assisted by junior surgeons--43% (46/108), in comparison with teams formed by residents assisted by senior surgeons--22% (25/108). The nondissecable fibrotic shirt front, woody inflammation of the pedicle, adhesions after past surgery and suspicion of a fistula are the most frequent causes of conversion--45.35% (49/108). The distribution according to the gender was analysed in patients which underwent conversion, showing a significant difference: 5.39% (60/1112) in women and 11.7% (48/410) in men. The percentage of conversion was significantly higher for operations performed at more than 96 hours away from the beginning of the symptoms--15.1% (29/192). The highest number of conversions occurred for gangrenous acute cholecystitis--72% (77/108). 82.40% of all the acute cholecystitis which were converted were complicated with shirt front (89/108). CONCLUSIONS: Conversion performed for laparoscopic cholecystectomies is a proof of ripening and professional responsibility, a fit solution for cases in which the advantages of laparoscopic surgery are overwhelmed by the risks found during surgery; gangrenous acute cholecystitis is one of the most important causes of conversion--72%; the shirt front around the gallbladder was converted in 82.4% of cases; conversion is more frequent in men--11.7%; acute cholecystitis with symptoms found for more than 96 hours are converted in 15.1% of cases.

Antibiotherapy and pathogenesis of uncomplicated UTI: difficult relationships.

In a time when conventional antibiotics are becoming increasingly less effective for treatment of infections, the relationship between bacteria and antimicrobial resistance is becoming more and more complicated. This paper provides a current review of studies reported in the literature pertaining to the antibiotherapy of human urinary tract infections (UTI), in a way that helps the reader direct a bibliographic search and develop an integrated perspective of the subject. Highlights are given to (bio)pathogenesis of uncomplicated cystitis. Features associated with the antibiotherapy of UTI such as development of resistance are presented in the text systematically. This review discusses recent advances in the understanding of how the predominant uropathogen Escherichia coli interacts with its host and leads to infection; so one can understand some of the reasons behind antibiotherapy failures.

The influence of the mode of administration in the dissemination of three coliphages in chickens.

Escherichia coli can cause severe respiratory and systemic infections in chickens, and it is often associated with significant economic losses in the poultry industry. Bacteriophages (phages) have been shown to be potential alternatives to the antibiotics in the treatment of bacterial infections. To accomplish that, phage particles must be able to reach and remain active in the infected organs. The present work aims at evaluating the effect of the route of administration and the dosage in the dissemination of 3 coliphages in the chicken's organs. In vivo trials were conducted by infecting chickens orally, spray, and i.m. with 10(6), 10(7), and 10(8) plaque-forming units/mL suspensions of 3 lytic phages: phi F78E (Myoviridae), phi F258E (Siphoviridae), and phi F61E (Myoviridae). Birds were killed 3, 10, and 24 h after challenge and the phage titer was measured in lungs and air sacs membranes, liver, duodenum, and spleen. When administered by spray, the 3 phages reached the respiratory tract within 3 h. Oral administration also allowed all phages to be recovered in lungs, but only phi F78E was recovered from the duodenum, the liver, and the spleen. These differences can be explained by the possible replication of phi F78E in commensal E. coli strains present in the chicken gut, thus leading to a higher concentration of this phage in the intestines that resulted in systemic circulation of phage with consequent phage in organs. When phages were administered i.m., they were found in all of the collected organs. Despite this better response, i.m. administration is a nonpracticable way of protecting a large number of birds in a poultry unit. In general, the results suggest that oral administration and spray allowed phages to reach and to remain active in the respiratory tract and can, therefore, be considered promising administration routes to treat respiratory E. coli infections in the poultry industry.

In vivo toxicity study of phage lysate in chickens.

1. Bacteriophage (phage) crude lysate of Gram-negative bacteria often contains bacterial debris, including lipopolysaccharides found in the outer membrane of the cell wall, which are potentially toxic. 2. In this study, an in vivo evaluation of the toxicity of a suspension of three phages to control pathogenic Escherichia coli strains in poultry was performed. 3. Eighteen commercial layers, 7 weeks old, were intramuscularly injected with phage lysate (8.21 x 10(4) Endotoxin Units/dose). The control group was injected with sterile Luria Bertani (LB) broth. 4. Bird prostration and decrease in body weight gain and water intake per gram of body weight were observed only on the day of the inoculation in the challenged group. Over the following 6 d, no differences were observed in the chickens' activity. 5. These results support the view that phage crude lysate carrying endotoxins are not toxic for chickens.

Demetrius Cantemir: the first account of transabodominal approach to repair groin hernia.

The first description of the transabdominal approach for hernia repair was written by Demetrius Cantemir, Prince of Moldavia and encyclopedic scholar, in his 1716 Latin manuscript "Incrementa et decrementa Aulae Othomaniae" ("The history of the Growth and Decay of the Ottoman Empire"). This manuscript was one of the most important in Eastern Europe at the time. It was first translated in English in 1734 by N. Tyndal, and all subsequent translations into various other languages were based on this english version. The original manuscript now belongs to the Houghton Library of Harvard University, where it was recently discovered in 1984 by V. Candea. Our article presents for the first time the complete account of the surgical procedure performed by Albanian physicians in the prince's palace in Constantinopol. The patient was the Prince's secretary. There is a detailed description of the operation, postoperative therapy and the medical course to recovery. The text presented is translated in English from Annotations of Volume Two, chapter four. We consider it worthwhile to present to the medical community this valuable but less known contribution to the history of medicine.

[Diagnostic yield of paediatric respiratory samples in the Balearic Islands Sentinel Influenza Surveillance Network]. / Rentabilidad de las muestras respiratorias pediátricas en la red centinela de vigilancia de la gripe en las Islas Baleares.

INTRODUCTION: Influenza disease is subjected to surveillance by national networks (RC) that predict the epidemic behaviour by reporting clinical and virological data. OBJECTIVES: To evaluate the effectiveness of the paediatric respiratory samples in the Balearic Islands RC in the last five epidemic seasons. MATERIAL AND PATIENTS: A breath sample was taken from paediatric patients in the RC who had flu symptoms. The samples were inoculated in the MDCK cell line. We reviewed the epidemiological data of patients with a culture positive to influenza A and B. RESULTS: A total of 338 pharyngeal swabs from the RC were analysed during the study period. Of these, 65 (19.3%) belonged to <14 years old patients, and 44.6% of the samples were positive as opposed to 39.1% of adult respiratory samples. The influenza A virus was isolated in 24 paediatric samples (82.7%) and the influenza B virus in 5 (17.3%). The mean age of the paediatric patients of the RC who were positive was 8.5 years. Only 3 patients in the 0-4 year old group were positive (10.3%) and 26 patients (89.7%) in the 5-14 years old group. CONCLUSIONS: In spite that paediatricians represented only 22% of the RC doctors and obtain the 19.3% of all respiratory samples, the percentage and effectiveness of these is higher that that obtained in the adult population.