Trichinella britovi outbreak: Epidemiological, clinical, and biological features.

OBJECTIVES: We aimed to describe the first cases of human trichinellosis due to Trichinella britovi in Serbia. A large trichinellosis outbreak due to the consumption of wild boar meat products took place during the 2015-2016 winter. PATIENTS AND METHODS: In January 2016, the Department of Infectious Diseases in Uzice examined 111 individuals with clinical and biological signs of trichinellosis, of whom 19 were hospitalized. Trichinella species identification was performed by multiplex PCR. Serodiagnosis was performed using immunofluorescence antibody assay, indirect ELISA, and Western Blot as confirmatory tests. RESULTS: The main symptoms included myalgia (83%), weakness (82%), joint pain (80%), fever (77%), facial edema (74%), and diarrhea (23%). Eosinophil levels>500/µl were observed in 98% of patients. Elevated CPK levels were detected in 71% of patients and elevated LDH levels in 75%. Three patients had cardiac complications. Treatment included mebendazole, nonsteroidal anti-inflammatory drugs, and corticosteroids. Anti-Trichinella antibodies were observed in 89.7% of patients two months after disease onset, including all hospital-treated patients. Among them, serum positivity detected one year later was 100%. CONCLUSIONS: This outbreak highlighted communication failures, from hunters to consumers. Awareness should be raised on the relation between trichinellosis and game meat. Trichinella species detection is important for adequate outbreak recording and could contribute to better understanding the clinical and serological signs of T. britovi infection.

Estimation of vertical walking ground reaction force in real-life environments using single IMU sensor.

Monitoring natural human gait in real-life environments is essential in many applications, including quantification of disease progression, monitoring the effects of treatment, and monitoring alteration of performance biomarkers in professional sports. Walking ground reaction forces are among the key parameters necessary for gait analysis. However, these parameters are commonly measured using force plates or instrumented treadmills which are expensive and bulky and can only be used in a controlled laboratory environment. Despite the importance of real-life gait measurement, developing reliable and practical techniques and technologies necessary for continuous real-life monitoring of gait is still an open challenge, mainly due to the lack of a practical and cost-effective wearable technology for ground reaction force measurement. This paper presents a methodology to estimate the total walking ground reaction force GRFvt in the vertical direction using data from a single inertial measurement unit. Correlation analysis of the vertical acceleration of different body segments with GRFvt indicated that the 7th cervical vertebrae is one of the best locations for the sensor. The proposed method improves the accuracy of the state-of-the-art GRFvt estimation by 25%, by utilising the time-varying ratio of the vertical acceleration of the human body centre of mass and measured C7 vertical acceleration. Results of this study showed that the proposed method estimated consistently the GRFvt in both indoor and urban outdoor environment, with a 4-8% peak-to-peak normalised root mean square error.

Live and inactivated vaccine regimens against caecal Salmonella Typhimurium colonisation in laying hens.

OBJECTIVE: In Australia, Salmonella serovar Typhimurium (S. Typhimurium) is the predominant zoonotic serovar in humans and is frequently isolated from layer hens. Vaccination against this serovar has been previously shown to be effective in broilers and the aim of this current study was to assess and determine the best vaccination strategy (live or inactivated) to minimise caecal colonisation by S. Typhimurium. METHODS: A long-term experiment (56 weeks) was conducted on ISABROWN pullets using a commercial live aroA deleted mutant S. Typhimurium vaccine and an autogenous inactivated multivalent Salmonella vaccine (containing serovars Typhimurium, Infantis, Montevideo and Zanzibar). These vaccines were administered PO or by SC or IM injection, either alone or in combination. Pullets were vaccinated throughout rearing (to 18 weeks of age) and sequentially bled for antibody titre levels. The birds, vaccinated and controls, were challenged orally with a field isolate of S. Typhimurium at different ages, held for 21 days post-challenge, then euthanased and their caeca cultured for the presence of Salmonella. RESULTS: None of the oral live-vaccinated groups exhibited lasting protection. When administered twice, the inactivated vaccine gave significant protection at 17 weeks of age and the live vaccine given by SC injection given twice produced significant protection at 17, 25 and 34 weeks. CONCLUSIONS: Vaccination regimens that included parenteral administration of live or inactivated vaccines and thus achieved positive serum antibody levels were able to provide protection against challenge. Hence, vaccination may play a useful role in a management strategy for Salmonella carriage in layer flocks.

Rationale for more consistent choice of surgical approaches for acetabular fractures.

OBJECTIVES: All acetabular fractures are difficult to treat surgically, but there are four types involving two columns that are particularly challenging. The choice of surgical approach is crucial. The purpose of the study was to determine and evaluate the factors influencing the choice of surgical approach for two-column acetabular fractures. We hypothesised that more accurate preoperative planning, sophisticated technical capabilities, and evolution of surgeon experience will result in more consistent use of non-extensile single surgical approaches. We also evaluated the outcomes of surgical treatment and the correlation with the surgical approach used. DESIGN: Retrospective cohort study. PATIENTS AND METHODS: A total of 156 patients with 157 acetabular fractures involving two columns (Letournel T-types and both-column) treated surgically in a 25-year period (1988-2013) were included in the study. The acetabular fractures in this study were divided into two groups according to the date of surgery: 81 in Group 1 (1998-2002) and 76 in Group 2 (2003-2013). All fractures were classified preoperatively according to the Judet and Letournel classification system and Matta's categorisation of surgical approach. Four surgical approaches were used: single Kocher-Langenbeck (KL), single ilioinguinal (II), combined Kocher-Langenbeck and ilioinguinal (KL+II), and extended iliofemoral (EIF). The efficacy of the surgical approach utilised was assessed using three parameters: anatomical reduction, surgical time and intraoperative complications. RESULTS: There was no statistical difference between Group 1 and Group 2 in the distribution of T-type (p=0.424) and both-column (p=0.425) fractures. In Group 2 more acetabular fractures were treated through single non-extensile approaches compared with Group 1 (90.8% vs. 54.3%, p<0.001). Increase in single approach surgery resulted in shorter mean surgical time (p<0.001) and significant increase in anatomical reduction (p=0.039). The frequency of intraoperative complications was not statistically different (p=0.07) between the two groups, but there was a trend to fewer complications in Group 2. CONCLUSIONS: The surgical approaches chosen for acetabular fractures that involve two columns (Letournel T-types and both-column) should become more consistent. The results of this study indicate that the majority of such acetabular fractures can be treated successfully through single surgical approaches.

Classification of Salmonella enterica serotypes from Australian poultry using repetitive sequence-based PCR.

AIMS: To evaluate a semi-automated repetitive extragenic palindromic sequence-based PCR (rep-PCR) system for the classification of Salmonella serotypes from Australian poultry. METHODS AND RESULTS: Using a DNA fingerprint library within the DiversiLab(®) System, four separate databases were constructed (serogroup B, C, E and Other). These databases contained 483 serologically confirmed (reference laboratory) Salmonella isolates. A blinded set of Salmonella cultures (n = 155) were typed by rep-PCR, matched against the internal library and compared with traditional serotyping. The predicted (Kullback-Leibler) serotype of 143 (92·3%) isolates matched traditional typing (P < 0·05). Of the 12 (7·7%) remaining isolates, ten (6·5%) resulted in 'No Match', one (0·65%) was incorrectly matched to the library (Salm. subsp 1 ser 4,12:-:-), and the other (0·65%) was referenced as Salm. ser. Sofia, whereas rep-PCR and in-house serotyping concurred as Salmonella serovar Typhimurium. Financial analysis showed higher material cost (215%) and a lower labour component (47·5%) for rep-PCR compared with serotyping. CONCLUSION: The DiversiLab(®) System, with serogroup databases, was successfully implemented as an adjunct for reference serotyping of Salmonella enterica. SIGNIFICANCE AND IMPACT OF THE STUDY: The DiversiLab(®) System platform is a cost-effective and easy-to-use system, which can putatively determine Salmonella enterica serotypes within a few hours.

A validated miniaturized MPN method, based on ISO 6579:2002, for the enumeration of Salmonella from poultry matrices.

AIMS: To validate the effectiveness of a miniaturized most probable number method (mMPN) in enumerating Salmonella from poultry matrices. METHODS AND RESULTS: A MPN was developed, based on the ISO 6579:2002 method using modified semi-solid Rappaport-Vassiliadis media as the sole selective medium. The validation of the mMPN was shown to not differ significantly from, at the 95% confidence level (Student's t-test P = 0·357) to, the traditional 9-tube MPN (tMPN) using pure cultures of Salmonella ser. Typhimurium, Infantis, Montevideo, Muenster and Salmonella subsp II 1,4,12,27:b:[e,n,x] (Sofia). The validation of naturally and artificially contaminated poultry matrices (carcasses, scald tank water, faeces, caeca and feed) showed that detection using the mMPN compared well to the ISO 6572:2002; sensitivity (92%), specificity (97%) and agreement (KAPPA 0·72). The quantitative comparison between the tMPN and mMPN methods showed that 92% of enumerations were less than ± 1 log different (Student's t-test = 0·13). Financial analysis showed that the mMPN required 64% less media and 56% less labour than the tMPN. CONCLUSION: The mMPN is a consistent, easy to automate method for the enumeration of Salmonella from different poultry matrices. SIGNIFICANCE AND IMPACT OF STUDY: The miniaturized MPN reduces the material and labour cost of the method and enables the uniform and accurate measurement of the effectiveness of intervention strategies in the control of Salmonella colonization of poultry.

Advances in enteropathogen control in poultry production.

Poultry meat has been associated frequently and consistently with the transmission of enteric pathogens, including Salmonella and Campylobacter. This association has resulted in the development of HACCP-based intervention strategies. These strategies (hurdles) begin with elite breeder flocks and filter down the production pyramid. These hurdles include those already established, such as biosecurity, vaccination, competitive exclusion, pre- and probiotics, feed and water control, and those more experimental, such as bacteriophage or immunoglobulin therapy. The reduction in enteropathogens entering the processing plant, which employs critical control points, further reduce the exposure of consumers to these organisms. The synergistic application of hurdles will result in an environment that is restrictive and detrimental to enteropathogen colonization and contamination.

Organization and functioning of the front-line surgical station at Rama in Bosnia and Herzegovina.

The war in the Republic of Bosnia and Herzegovina has imposed specific tasks upon civil surgical work and forced it to adapt to war conditions. To this end, mobile surgical teams were formed, functioning within the front-line surgical stations. The organization and the results of work of such a front-line surgical station at Rama in the Republic of Bosnia and Herzegovina are described. In the course of more than 5 months (April 9-September 23, 1992), 179 wounded persons were retained for further treatment in the stationary unit of the station, while 10.6% were transported to the nearest hospital. The mortality of the wounded was 1.7%; it would have been significantly lower had there been the possibility of air transport for the wounded.

[Benign mesenchymal tumors of the uterus]. / O benignim mezenhimnim tumorima uterusa.

Benign mesenchymal tumours of the uterus are discussed. The results are compared with those of other authors and respective epidemiological findings are put forward. Clinical and histological characteristics of uterine myomas and adenomyomas are described in more detail. Irregular bleeding is most frequent among clinical symptoms; it is caused by the persistence of the proliferative endometrium. The secretory conversion of the ectopic endometrium in adenomyoma appears in the glandular epithelium only, while the stromal response to progesteron activity seems inadequate. Maturation of the ectopic and the uterine endometrium is discordant. The cause is the retardation of both the proliferative and secretory phases in the ectopic endometrium. After secretory conversion of the ectopic endometrium the exhaustion and destruction of glands appears. The regeneration of the ectopic endometrium fails to occur because of the absence of the basal layer in the ectopic endometrium. Therefore the authors suppose that the regression of the ectopic endometrium in adenomyomas might be the result of ovulatory cycles.