Detection of pathogenic Vibrio spp. in foods: polymerase chain reaction-based screening strategy to rapidly detect pathogenic Vibrio parahaemolyticus, Vibrio cholerae, and Vibrio vulnificus in bivalve mollusks and preliminary results.

The majority of human diseases attributed to seafood are caused by Vibrio spp., and the most commonly reported species are Vibrio parahaemolyticus, Vibrio vulnificus, and Vibrio cholerae. The conventional methods for the detection of Vibrio species involve the use of selective media, which are inexpensive and simple but time-consuming. The present work aimed to develop a rapid method based on the use of multiplex real-time polymerase chain reaction (PCR) to detect V. parahaemolyticus, V. vulnificus, and V. cholerae in bivalve mollusks. 30 aliquots of bivalve mollusks (Mytilus galloprovincialis) were experimentally inoculated with two levels of V. parahaemolyticus, V. vulnificus, and V. cholerae. ISO 21872-1:2017 was used in parallel for qualitative analysis. The limit of detection of 50% was 7.67 CFU/g for V. cholerae, 0.024 CFU/g for V. vulnificus, and 1.36 CFU/g for V. parahaemolyticus. For V. vulnificus and V. cholerae, the real-time PCR protocol was demonstrated to amplify the pathogens in samples seeded with the lowest and highest levels. The molecular method evaluated showed a concordance rate of 100% with the reference microbiological method. V. parahaemolyticus was never detected in samples contaminated with the lowest level, and it was detected in 14 samples (93.33%) seeded with the highest concentration. In conclusion, the developed multiplex real-time PCR proved to be reliable for V. vulnificus and V. cholerae. Results for V. parahaemolyticus are promising, but further analysis is needed. The proposed method could represent a quick monitoring tool and, if used, would allow the implementation of food safety.

Spiral multidetector computerized tomography evaluation of adjustable continence therapy implants.

PURPOSE: ProACT is an adjustable continence therapy implant for post-prostatectomy incontinence. We evaluated the exact device location in clinical success and failed implant cases using spiral multidetector computerized tomography. MATERIALS AND METHODS: We evaluated 18 consecutive patients postoperatively using pelvic spiral multidetector computerized tomography. Of the patients 11 (61%) were dry or improved and 7 (39%) had not improved despite multiple balloon adjustments. Thin pelvic collimated scans with bone algorithm were obtained, completed by multiplanar reformatting and a volume rendering technique. The computerized tomography technique is described. RESULTS: Multidetector computerized tomography showed device sites compared to local anatomical structures. In 64% of dry or improved patients the devices were above the urogenital diaphragm and adjacent to the urethral wall (the correct position) while in the remaining 36% of cured patients only 1 device was positioned correctly. Of nonimproved patients 86% had balloons that were not adjacent to the urethra. The scout view did not show malpositioning in any of these cases. Only multiplanar reformatting with the volume rendering technique revealed misplacement. CONCLUSIONS: Multidetector computerized tomography data shows that a poor outcome in most failed cases results from poor device positioning. In a few failed cases an unsuccessful result is probably caused by excessive tissue sclerosis. To our knowledge we report for the first time how continence can be determined by the action of only 1 device.

Dying in the intensive care unit: collaborative multicenter study about forgoing life-sustaining treatment in Argentine pediatric intensive care units.

OBJECTIVE: Describe modes of death and factors involved in decision-making together with life support limitation (LSL) procedures. DESIGN: Prospective, descriptive, longitudinal, and noninterventional study. SETTING: Sixteen pediatric intensive care units in Argentina. PATIENTS: Every patient who died during a 1-yr period was included. MEASUREMENTS AND MAIN RESULTS: Age, sex, length of stay (LOS), primary and admission diagnosis, underlying chronic disease (CD), postoperative condition (PO). Deaths were classified in four groups: a) failed cardiopulmonary resuscitation (CPR); b) do-not-resuscitate (DNR) status; c) withholding or withdrawing life-sustaining treatment (WH/WD); and d) brain death (BD). Justifications were classified as a) imminent death; b) poor long-term prognosis; c) poor quality of life; and d) family request. Data were collected from medical records and interviews with the attending physicians. Descriptive statistics were performed. Differences among groups were analyzed through contingency tables and analysis of variance when required. Relative risks and confidence intervals of variables potentially related to LSL were analyzed, and logistic regression was performed. There were 6358 admissions and 457 deaths. CPR was performed in 52%, DNR in 16%, WH/WD in 20%, and BD in 11% of dead patients. BD patients were older, LOS and CD prevalence were higher in the WH/WD group. Inotropic drugs were the most frequently limited treatment in 110 patients (55%), CPR in 72 (35.6%), and mechanical ventilation in 63 (31%). Imminent death was the most frequently reported justification for LSL. CD and more staff were associated with a higher probability of LSL. CONCLUSIONS: Most of the patients in Argentina underwent CPR before their death. We have a high proportion of patients with CD (65%) and low BD diagnosis. PO condition decreased LSL probability in chronically ill patients. Do-not-resuscitate orders and withholding new treatments were the most common LSL. Active withdrawal was exceptional. The Ethics Committee was consulted in 5% of the LSL population.