Prevalence and antimicrobial resistance of Salmonella serovars isolated from poultry in Ghana.

Poultry are possible sources of non-typhoidal Salmonella serovars which may cause foodborne human disease. We conducted a cross-sectional study to determine the prevalence of Salmonella serovars in egg-laying hens and broilers at the farm level and their susceptibility to antimicrobials commonly used in the poultry industry in Ghana. Sampling of faeces by a sock method (n = 75), dust (n = 75), feed (n = 10) and drinking water (n = 10) was performed at 75 commercial egg-laying and broiler farms in two regions of Ghana and skin neck (n = 30) at a local slaughterhouse from broilers representing different flocks. Salmonella was detected in 94/200 (47%) samples with an overall flock prevalence of 44·0%. Sixteen different serovars were identified with S. Kentucky (18·1%), S. Nima (12·8%), S. Muenster (10·6%), S. Enteritidis (10·6%) and S. Virchow (9·6 %) the most prevalent types. The predominant phage type of S. Enteritidis was PT1. All strains were susceptible to cefotaxime, ceftazidime and cefoxitin. Fifty-seven (60·6%) strains were resistant to one or more of the remaining nine antimicrobials tested by disk diffusion, of which 23 (40·4%) showed multi-resistance (resistance to ⩾3 classes of antimicrobials). Of the resistant strains (n = 57), the most significant were to nalidixic acid (89·5%), tetracycline (80·7%), ciprofloxacin (64·9%), sulfamethazole (42·1%), trimethoprim (29·8%) and ampicillin (26·3%). All S. Kentucky strains were resistant to more than two antimicrobials and shared common resistance to nalidixic acid or ciprofloxacin and tetracycline, often in combinations with other antimicrobials. PFGE analysis using XbaI of S. Kentucky demonstrated one dominant clone in the country. In conclusion, poultry produced in Ghana has a high prevalence of multi-resistant Salmonella and the common finding of clonal S. Kentucky in the Kumasi area warrants further investigations into the epidemiology of this serovar. There is an urgent need for surveillance and control programmes on Salmonella and use of antimicrobials in the Ghanaian poultry industry to protect the health of consumers.

Attribution of human Salmonella infections to animal and food sources in Italy (2002-2010): adaptations of the Dutch and modified Hald source attribution models.

The Dutch and modified Hald source attribution models were adapted to Italian Salmonella data to attribute human infections caused by the top 30 serotypes between 2002 and 2010 to four putative sources (Gallus gallus, turkeys, pigs, ruminants), at the points of animal reservoir (farm), exposure (food), and both combined. Attribution estimates were thus compared between different models, time periods and sampling points. All models identified pigs as the main source of human salmonellosis in Italy, accounting for 43-60% of infections, followed by G. gallus (18-34%). Attributions to turkeys and ruminants were minor. An increasing temporal trend in attributions to pigs and a decreasing one in those to G. gallus was also observed. Although the outcomes of the two models applied at farm and food levels essentially agree, they can be refined once more information becomes available, providing valuable insights about potential targets along the production chain.

A multistate epidemic outbreak of Salmonella Goldcoast infection in humans, June 2009 to March 2010: the investigation in Italy.

After an urgent inquiry into a suspected international outbreak of Salmonella Goldcoast infection was launched by Hungary in October 2009 a nationwide multidisciplinary investigation was carried out in Italy. The aims were to verify whether the higher than expected number of cases of S. Goldcoast infection that had occurred in Italy in the previous months were linked to the outbreak in Hungary and to determine their origin. Between June 2009 and March 2010, 79 confirmed cases of S. Goldcoast infection were identified. Of these, 17 were part of three different point-source outbreaks probably associated with the consumption of salami. Eating salami was also reported by 20 of the 39 sporadic cases that could be interviewed. Fifteen strains of S. Goldcoast isolated from the cases were typed by pulsed-field gel electrophoresis. They shared more than 90% homology with the Hungarian epidemic strain and were also highly similar to S. Goldcoast strains that had been isolated in Italy from pigs and pork-containing food items in 2009 and 2010. Although the origin of the outbreak and the common source linking the Hungarian and the Italian cases could not be definitively identified, our results suggest a possible zoonotic connection of the outbreak cases with the pork production chain.

[Guide to buying a camera for dermatological photography]. / Guía para la compra de una cámara fotográfica para Dermatología.

Choosing a camera for use in the dermatology office is difficult, particularly in the case of a digital camera because the market is constantly evolving. This article explains the features that should be taken into account, including camera type, sensor, lens and macro capability, aperture priority mode, screen, viewfinder, operating speed, flash, battery, memory card, and image format. The most recent advances in the field of digital photography relevant to the dermatologist are discussed.

Antimicrobial resistance of Escherichia coli and Enterococcus faecalis in housed laying-hen flocks in Europe.

The aim of this study was to determine the potential association between housing type and multiple drug resistance (MDR) in Escherichia coli and Enterococcus faecalis isolates recovered from 283 laying-hen flocks. In each flock, a cloacal swab from four hens was collected and produced 1102 E. coli and 792 E. faecalis isolates. Broth microdilution was used to test susceptibility to antimicrobials. Country and housing type interacted differently with the MDR levels of both species. In the E. coli model, housing in a raised-floor system was associated with an increased risk of MDR compared to the conventional battery system [odds ratio (OR) 2·12, 95% confidence interval (CI) 1·13-3·97)]. In the E. faecalis model the MDR levels were lower in free-range systems than in conventional battery cages (OR 0·51, 95% CI 0·27-0·94). In Belgium, ceftiofur-resistant E. coli isolates were more numerous than in the other countries.

Hyperopic Q-optimized algorithms: a theoretical study on factors influencing optical quality.

In this work, we analyze the way in which pupil size, optical zone, and initial hyperopic level influence optical quality for hyperopic Q-optimized corneal refractive surgery. Different Q-optimized algorithms and the Munnerlyn formula were tested to analyze the optical quality of the final retinal image for initial hyperopic errors from 1D to 5D. Three optical zones (5.5, 6, and 6.5 mm) and two pupil diameters (5 and 7 mm) were considered. To evaluate optical quality, we computed the modulation transfer function (MTF) and the area under MTF (MTFa). Q-optimized values at around Q = -0.18 were found to provide the best optical quality for most of the conditions tested. This optimum final asphericity for hyperopic ablation was not depending on the degree of hyperopia corrected, the optical zone or the pupil size being this information important for clinical practice.

Distribution of Salmonella Serovars and Antimicrobial Susceptibility from Poultry and Swine Farms in Central Vietnam.

This study was conducted to estimate the prevalence of Salmonella spp. and their antimicrobial susceptibilities on poultry and swine farms, sampled in 2 regions in Central Vietnam. A total of 67 poultry farms and 46 swine farms were sampled in a period of 5 months (from September 2012 to January 2013). Salmonella spp. was prevalent in 46.3% and 71.7% of poultry and swine farms, respectively. Altogether, 99 non-typhoidal Salmonella were isolated and the most common serovars were Salmonella Weltevreden (19%), followed by Salmonella Typhimurium (12%) and Salmonella 4,[5],12:i:- (11%). Overall, 71 of 99 (72%) Salmonella isolates were resistant to at least one of the 14 antimicrobial agents tested. Both in poultry and swine farms, high levels of resistance were observed for ampicillin, chloramphenicol, ciprofloxacin, sulphamethoxazole and tetracycline. The presence of Salmonella isolates from poultry and swine farms which were resistant to different classes of antimicrobials suggests that alternative control measures to antimicrobials should be implemented. Moreover, an effective policy should be promoted to encourage a prudent use of these agents in animal farming in Vietnam.

ESTES guidelines: acute mesenteric ischaemia.

PURPOSE: Acute mesenteric ischaemia (AMI) accounts for about 1:1000 acute hospital admissions. Untreated, AMI will cause mesenteric infarction, intestinal necrosis, an overwhelming inflammatory response and death. Early intervention can halt and reverse this process leading to a full recovery, but the diagnosis of AMI is difficult and failure to recognize AMI before intestinal necrosis has developed is responsible for the high mortality of the disease. Early diagnosis and prompt treatment are the goals of modern therapy, but there are no randomized controlled trials to guide treatment and the published literature contains a high ratio of reviews to original data. Much of that data comes from case reports and often small, retrospective series with no clearly defined treatment criteria. METHODS: A study group of the European Society for Trauma and Emergency Surgery (ESTES) was formed in 2013 with the aim of developing guidelines for the management of AMI. A comprehensive literature search was performed using the Medical Subject Heading (MeSH) thesaurus keywords "mesenteric ischaemia", "bowel ischaemia" and "bowel infarction". The bibliographies of relevant articles were screened for additional publications. After an initial systematic review of the literature by the whole group, a steering group formulated questions using a modified Delphi process. The evidence was then reviewed to answer these questions, and recommendations formulated and agreed by the whole group. RESULTS: The resultant recommendations are presented in this paper. CONCLUSIONS: The aim of these guidelines is to provide recommendations for practice that will lead to improved outcomes for patients.

A comparative study of successive and simultaneous methods in colour discrimination.

Simultaneous and successive methods of comparison of stimuli are studied by comparing experimental results of colour discrimination experiments. In this way, colour differential thresholds for two normal observers and four different stimuli were measured by the two methods. In most cases, the capacity to discriminate colour decreased when the successive method was used, although no differences were found in qualitative aspects of discrimination. These results differ somewhat from previous reports in this field, probably because of experimental differences in the method of obtaining the thresholds.

Influence of the luminance and opponent chromatic channels on stereopsis with random-dot stereograms.

The present work examines the relationship between random-dot stereograms (via the disparity range parameter) and color-vision mechanisms (via the luminance channel and red-green and tritan directions at isoluminance). The results clearly indicate that the variations in the stereograms along red-green confusion lines contribute to stereopsis. Stereoscopic perception depends on spatial information for stereograms generated with variations along tritan confusion lines. For observers who perceive stereopsis via tritan directions, the results show a gradation in the disparity range, with the disparity range for stereograms generated by luminance variations being greater than for stereograms generated in red-green directions; the latter range is, in turn, greater than for stereograms generated along tritan directions.

The effect of pupil size on binocular summation at suprathreshold conditions.

PURPOSE: To determine the influence of retinal illuminance on monocular or binocular visual reaction time (VRT). METHODS: On two normal subjects, uniform circular stimuli were presented with respect to a reference stimulus at the fovea under suprathreshold conditions, and the detection of positive and negative luminance variations was recorded. Binocular and monocular reaction times were measured (by the index finger pressing on a mouse key) for viewing with both natural and artificial pupils. RESULTS: Binocular reaction times were shorter than monocular reaction times; nevertheless, this binocular-summation effect was less marked in trials with the artificial pupil. Analyses of binocular-summation ratios for contrast changes for both pupil types indicated maximum and minimum binocular-saturation values depending on contrast variations in both positive and negative luminance changes. CONCLUSIONS: Binocular summation can be influenced by pupil size under suprathreshold conditions. Results are discussed in terms of retinal illuminance and cortical pupil response mechanisms.

[Prevalence and control of arterial hypertension in the adult population of the Valencian community, 1994]. / Prevalencia y control de la hipertensión arterial en la población adulta de la Comunidad Valenciana, 1994.

BACKGROUND: High blood pressure (HBP) is probably one of the main targets for prevention in primary health care. Knowledge of the magnitude and control is needed for monitoring this health problem at the population level. The aim of this study was to estimate the prevalence of hypertension in the adult population of Valencian Region (VR) (Spain), and to evaluate the degree of treatment and control. SUBJECTS AND METHODS: Two measurements of blood pressure (BP) were obtained for a representative sample of 1,674 participants (14 years and older) in the nutrition and health survey of the VR in 1994. A semi-automatic digital esfingmomanometer was used. HBP definition was based on the criteria of the WHO and the Fifth Joint National Committee on Detection Evaluation and Treatment on HBP. Criteria of the MONICA project were used to determine the level of treatment and control of hypertension. Prevalence of HBP was estimated for sex and age groups accounting for the study design. RESULTS: HBP prevalence was 31.7% (14.1% borderline HBP plus 17.6% defined HBP). Hypertension increased with age from a prevalence of 9.3% in the group 15-24 years of age, to 68.8% in the group > or = 65 years old. A 57% of hypertensive persons were not under treatment, a 16.6% were treated but their BP was not controlled, and a 26.4% were under treatment and presents controlled BP. The uncontrolled BP was more evident at younger ages. CONCLUSIONS: This study has shown that one third of the adult population from VR had HBP, and over the half of them are not treated. Furthermore, over one third of hypertensives under pharmacological treatment presented uncontrolled BP. These results should be taken into account if preventive actions are to be implemented at the individual and population level.

[Value of the Q-tip test in patients with urinary incontinence]. / Valor de la Prueba del Hisopo en pacientes con incontinencia urinaria.

We evaluated the accuracy of the Q-tip test to measure uretrhovesical junction mobility in patient's histories of urinary incontinence, and pelvic relaxation. A retrospective study of 183 files of patients with urinary incontinence and anterior vaginal wall relaxation in the Instituto Nacional de Perinatología (INPer) between march 1994 and may 1995. All patients underwent a systematic diagnosis evaluation with detailed history and physical examination including Q-test, neurology examination, urinary, urine culture, uretrhoscopy and urodinamic studies. We correlated Q-tip test pelvic relaxation to measure urethrovesical junction mobility. They were placed in three groups. Group I formed by stres incontinence, group II formed by mixed incontinence and group III formed by recurrent incontinence. Mean age 46.3 years (29-72), almost all the patients were multiparas, menopausal status in 72, with hormonal treatment 48. Q-tip test was not different between the groups. Group I had cystocele II with hipermobility statistically significant difference, the same in group II. No differences were found in the group III. We concluded that urethral position and mobility as measure by the Q-tip test are related to defects in interior vaginal support, but not to specific urologic diagnosis.

[Clinical characteristics of women with genital prolapse]. / Características clínicas de la mujer con prolapso genital.

Clinical features of severe urogenital prolapse, were studied. Fifteen patients were included in a retrospective study between January 1990 and June 1995. The diagnosis of severe uterine prolapse (where the cervix precedes the inverted vaginal tube) was the sole inclusion criteria. Age, parity, hormonal stage, occupation, simptomatology, body mass index, and the results of histopathological examinations were evaluated. The mean age was 60 years, parity most frequently observed was more than three, 80% were postmenopausal, the body mass index was 23.5, all patients were housewifes, the symptomatology that was present in 100% of the patients was the sensation of an intravaginal foreign material. The surgical treatment performed was vaginal hysterectomy. The results of histopathological examinations were in the most inflammation. The parity and postclimaterium were the principal factors associated with the pathogenesis of uterine prolapse.

[The correlation of the findings between the urological clinical history and urodynamic evaluation in urinary incontinence]. / Correlación de los hallazgos entre la historia clínica urológica y la evaluación urodinámica en incontinencia urinaria.

Patient's histories of urinary incontinence and results of several standard clinical tests, were correlated with final diagnosis obtained by multichannel urodynamic testing. One hundred and thirty one histories of women with urinary incontinence who were in the Urogynecology Clinics of the Instituto Nacional de Perinatología in the period from july to december 1992, were evaluated including dates of standardized questionnaire and structural clinical examination with the urodynamic testing to obtain a final diagnosis. Although the objective urinary loss and the cystocele II-III were significantly associated with genuine stress incontinence and mixed incontinence, in patients with detrusor instability did not. Women with complaints of urinary incontinence, especially those for whom surgery is contemplated, should undergo complete urodynamic evaluation.

[Bladder drainage in patients undergoing the Pereyra surgical procedure]. / Drenaje vesical en pacientes sometidas a operación Pereyra.

Postoperative acute urinary retention was evaluated in the patients who underwent Pereyra procedure. Comparison of suprapubic and urethral catheterization. Between January 1994 and July 1995, fifty two patients with urinary stress incontinence underwent Pereyra procedure, 31 female patient with suprapubic drainage (cistofix Ch 15) and 17 urethral catherization with a latex foley catheter. Sponatneous micturition and urinary retention was evaluated until the catheter was removed. Mean age was 43.8 years (32 a 66), the duration of suprapubic vesical drainage with suprapubic catheter were 3 days in 58.6% of the patients, and more than 3 days in 41.29%. Recatheterizacion in the patients with urethral drainage was more frequent. Urinary retention after 7 days was present in 23.99% with suprapubic vesical drainage and 28.5% with urethral catheter. Recatheterization is more frequent in patients with urethral catheter.

Characterization of an unusual Salmonella phage type DT7a and report of a foodborne outbreak of salmonellosis.

Salmonella enterica subsp. enterica serovar 4,[5],12,i:- is a monophasic variant of Salmonella Typhimurium and its occurrence has markedly increased in several European countries in the last ten years. In June 2011, an outbreak of Salmonella 4,[5],12,i:- was reported among attendees of a wedding reception in the North-East of Italy. The source of this outbreak was identified as a cooked pork product served during the wedding reception. All Salmonella isolates from humans and the contaminated pork products were identified as Salmonella 4,[5],12,i:- and phage typed as DT7a. Afterwards, the farm where the pigs were raised was identified and sampled, and Salmonella Typhimurium was isolated from swine fecal samples. Despite the difference in serovar, these Salmonella Typhimurium isolates were also phage typed as DT7a. In the present study, Salmonella isolates from animals, humans and pork products during the outbreak investigation were subtyped by pulsed-field gel electrophoresis (PFGE), Multiple-Locus Variable number tandem repeats Analysis (MLVA), and resistance patterns, aiming to identify the most suitable subtyping methods to characterize isolates associated with this outbreak. In addition, a collection of epidemiologically unrelated strains of Salmonella 4,[5],12,i:- and Salmonella Typhimurium sharing the same phage type (DT7a) was similarly characterized in order to investigate their genetic relationship. This study provides a first snapshot of a rare Salmonella phage type, DT7a, associated with both Salmonella 4,[5],12,i:- and Salmonella Typhimurium. Moreover, the study demonstrated that in this specific context MLVA could be a reliable tool to support outbreak investigations as well as to assess the genetic relatedness among Salmonella isolates.

Application of the Random Forest method to analyse epidemiological and phenotypic characteristics of Salmonella 4,[5],12:i:- and Salmonella Typhimurium strains.

Salmonella enterica 4,[5],12:i:- is a monophasic variant of S. Typhimurium. In the last decade, its prevalence rose sharply. Although S. 4,[5],12:i:- and S. Typhimurium are known to pose a considerable public health risk, there is no detailed information on the circulation of these serovars in Italy, particularly as far as veterinary isolates are concerned. For this reason, a data set of 877 strains isolated in the north-east of Italy from foodstuffs, animals and environment was analysed during 2005-2010. The Random Forests (RF) method was used to identify the most important epidemiological and phenotypic variables to show the difference between the two serovars. Both descriptive analysis and RF revealed that S. 4,[5],12:i:- is less heterogeneous than S. Typhimurium. RF highlighted that phage type was the most important variable to differentiate the two serovars. The most common phage types identified for S. 4,[5],12:i:- were DT20a, U311 and DT193. The same phage types were also found in S. Typhimurium isolates, although with a much lower prevalence. DT7 and DT120 were ascribed to the two serovars at comparable levels. DT104, DT2 and DT99 were ascribed exclusively to S. Typhimurium, and almost all the other phage types identified were more related to the latter serovar. Such data confirm that phage typing can provide an indication of the biphasic or monophasic state of the strains investigated and could therefore support serotyping results. However, phage typing cannot be used as the definitive method to differentiate the two serovars, as part of the phage types were detected for both serovars and, in particular, all phage types found for S. 4,[5],12:i- were found also for S. Typhimurium.

Determination of the within and between flock prevalence and identification of risk factors for Salmonella infections in laying hen flocks housed in conventional and alternative systems.

Salmonella outbreaks in humans are often linked with the consumption of contaminated eggs. Therefore a profound knowledge of the actual prevalence of Salmonella spp. in laying hens and the factors that influence the presence and persistence of Salmonella on a farm is of utmost importance. The housing of laying hens in conventional battery cages will be forbidden in the European Union (EU) from 2012 onwards. There is an urgent need to evaluate whether this move to alternative housing systems will influence the prevalence of Salmonella in laying hens. Therefore, a cross-sectional study was performed in 5 European countries (Belgium, Germany, Greece, Italy and Switzerland) to determine the between and within flock prevalence of hens shedding Salmonella and to investigate whether there is an effect of the housing type on Salmonella prevalence. In total 292 laying hen farms were sampled in the month prior to depopulation. An on-farm questionnaire was used to collect information on general management practices and specific characteristics of the sampled flock. Twenty-nine flocks were found positive for at least 1 Salmonella-serotype. In these flocks the within flock prevalence of shedding hens, determined by individual sampling of 40 hens, varied between 0% and 27.50%. A wide variety of serotypes was isolated with Salmonella Enteritidis as the most common. Housing in conventional battery cages, the absence of dry cleaning in between production rounds and sampling in winter turned out to be risk factors for the shedding of Salmonella Enteritidis or Typhimurium (P<0.05).