Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 36
Filtrar
1.
Emerg Infect Dis ; 29(7): 1357-1366, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37347505

RESUMO

More than 7.15 million cases of domestically acquired infectious waterborne illnesses occurred in the United States in 2014, causing 120,000 hospitalizations and 6,600 deaths. We estimated disease incidence for 17 pathogens according to recreational, drinking, and nonrecreational nondrinking (NRND) water exposure routes by using previously published estimates. In 2014, a total of 5.61 million (95% credible interval [CrI] 2.97-9.00 million) illnesses were linked to recreational water, 1.13 million (95% CrI 255,000-3.54 million) to drinking water, and 407,000 (95% CrI 72,800-1.29 million) to NRND water. Recreational water exposure was responsible for 36%, drinking water for 40%, and NRND water for 24% of hospitalizations from waterborne illnesses. Most direct costs were associated with pathogens found in biofilms. Estimating disease burden by water exposure route helps direct prevention activities. For each exposure route, water management programs are needed to control biofilm-associated pathogen growth; public health programs are needed to prevent biofilm-associated diseases.


Assuntos
Doenças Transmissíveis , Água Potável , Doenças Transmitidas pela Água , Humanos , Estados Unidos/epidemiologia , Doenças Transmissíveis/epidemiologia , Doenças Transmitidas pela Água/epidemiologia , Abastecimento de Água , Microbiologia da Água
2.
N Engl J Med ; 382(21): 2005-2011, 2020 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-32220208

RESUMO

BACKGROUND: Long-term care facilities are high-risk settings for severe outcomes from outbreaks of Covid-19, owing to both the advanced age and frequent chronic underlying health conditions of the residents and the movement of health care personnel among facilities in a region. METHODS: After identification on February 28, 2020, of a confirmed case of Covid-19 in a skilled nursing facility in King County, Washington, Public Health-Seattle and King County, aided by the Centers for Disease Control and Prevention, launched a case investigation, contact tracing, quarantine of exposed persons, isolation of confirmed and suspected cases, and on-site enhancement of infection prevention and control. RESULTS: As of March 18, a total of 167 confirmed cases of Covid-19 affecting 101 residents, 50 health care personnel, and 16 visitors were found to be epidemiologically linked to the facility. Most cases among residents included respiratory illness consistent with Covid-19; however, in 7 residents no symptoms were documented. Hospitalization rates for facility residents, visitors, and staff were 54.5%, 50.0%, and 6.0%, respectively. The case fatality rate for residents was 33.7% (34 of 101). As of March 18, a total of 30 long-term care facilities with at least one confirmed case of Covid-19 had been identified in King County. CONCLUSIONS: In the context of rapidly escalating Covid-19 outbreaks, proactive steps by long-term care facilities to identify and exclude potentially infected staff and visitors, actively monitor for potentially infected patients, and implement appropriate infection prevention and control measures are needed to prevent the introduction of Covid-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Instituições de Cuidados Especializados de Enfermagem , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico , Busca de Comunicante , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Surtos de Doenças , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Pessoal de Saúde , Humanos , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/mortalidade , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , SARS-CoV-2 , Washington/epidemiologia
3.
Wilderness Environ Med ; 32(1): 63-69, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33309199

RESUMO

We present the case of a patient who developed myalgia as the primary symptom of envenomation by the eastern coral snake, Micrurus fulvius. The patient was evaluated and treated in the emergency department. Physical examination did not demonstrate any neuromuscular abnormalities. On consultation with the poison control center, the patient's myalgia was determined to be an effect of envenomation, and 5 vials of North American coral snake antivenin were administered. The patient was admitted to the intensive care unit where his symptoms resolved. He was discharged the following day after remaining asymptomatic for 24 h.


Assuntos
Antivenenos/uso terapêutico , Cobras Corais , Venenos Elapídicos/toxicidade , Mialgia/etiologia , Mordeduras de Serpentes/terapia , Animais , Humanos , Masculino , Pessoa de Meia-Idade
4.
MMWR Morb Mortal Wkly Rep ; 69(20): 618-622, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32437343

RESUMO

Ceftriaxone-resistant Salmonella enterica serotype Typhi (Typhi), the bacterium that causes typhoid fever, is a growing public health threat. Extensively drug-resistant (XDR) Typhi is resistant to ceftriaxone and other antibiotics used for treatment, including ampicillin, chloramphenicol, ciprofloxacin, and trimethoprim-sulfamethoxazole (1). In March 2018, CDC began enhanced surveillance for ceftriaxone-resistant Typhi in response to an ongoing outbreak of XDR typhoid fever in Pakistan. CDC had previously reported the first five cases of XDR Typhi in the United States among patients who had spent time in Pakistan (2). These illnesses represented the first cases of ceftriaxone-resistant Typhi documented in the United States (3). This report provides an update on U.S. cases of XDR typhoid fever linked to Pakistan and describes a new, unrelated cluster of ceftriaxone-resistant Typhi infections linked to Iraq. Travelers to areas with endemic Typhi should receive typhoid vaccination before traveling and adhere to safe food and water precautions (4). Treatment of patients with typhoid fever should be guided by antimicrobial susceptibility testing whenever possible (5), and clinicians should consider travel history when selecting empiric therapy.


Assuntos
Ceftriaxona/farmacologia , Surtos de Doenças , Resistência Microbiana a Medicamentos , Salmonella typhi/efeitos dos fármacos , Doença Relacionada a Viagens , Febre Tifoide/epidemiologia , Febre Tifoide/microbiologia , Adolescente , Adulto , Idoso , Ceftriaxona/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Iraque/epidemiologia , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Febre Tifoide/tratamento farmacológico , Estados Unidos/epidemiologia , Adulto Jovem
5.
Clin Gerontol ; 43(4): 365-377, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31423915

RESUMO

OBJECTIVES: . The aim of this systematic literature review (SLR) was to investigate the effect of companion animals (whether simply as pets or used in more formal intervention approaches) on the physical and mental health of older adults (aged 60+). METHODS: . The reviewers identified key search terms and conducted a systematic search of the PsycINFO and PubMed databases. The 70 articles reviewed were evaluated through tabular and thematic analysis. RESULTS: . In 52 of the studies examined, companion animals positively contributed to the mental and/or physical health of older adults. With respect to mental health, involvement with a companion animal improved participant quality of life and effectively attenuated symptoms of depression, anxiety, cognitive impairment, and the behavioral and psychiatric symptoms of dementia (BPSD). In relation to physical health, marked increases in physical activity and improvements in blood pressure and heart rate variability were the only consistent physical health improvements observed from companion animal interactions. CONCLUSIONS: . Animal companionship can benefit the mental and physical health of older adults, although more and better controlled research on this topic is required. CLINICAL IMPLICATIONS: . Use of companion animals has the potential to be an effective treatment or adjunct therapy to improve the health status and quality of life of older individuals.


Assuntos
Terapia Assistida com Animais , Disfunção Cognitiva , Animais de Estimação , Idoso , Animais , Ansiedade , Humanos , Saúde Mental , Qualidade de Vida
7.
World J Surg ; 43(7): 1661-1668, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30788536

RESUMO

INTRODUCTION: Prehabilitation prior to major surgery has increased in popularity over recent years and aims to improve pre-operative conditioning of patients to improve post-operative outcomes. The beneficial effect of such protocols is not well established with conflicting results reported. This review aimed to assess the effect of prehabilitation on post-operative outcome after major abdominal surgery. METHODS: EMBASE, Medline, PubMed and the Cochrane database were searched in August 2018 for trials comparing outcomes of patients undergoing prehabilitation involving prescribed respiratory and exercise interventions prior to abdominal surgery. Study characteristics, overall and pulmonary morbidity, length of stay (LOS), maximum inspiratory pressure and change in six-minute walking test (6MWT) distance were obtained. The primary outcome was post-operative overall morbidity within 30 days. Dichotomous data were analysed by fixed or random effects odds ratio. Continuous data were analysed with weighted mean difference. RESULTS: Fifteen RCTs were included in the analysis with 457 prehabilitation patients and 450 control group patients. A significant reduction in overall (OR 0.63 95% CI 0.46-0.87 I2 34%, p = 0.005) and pulmonary morbidity (OR 0.4 95% CI 0.23-0.68, I2 = 0%, p = 0.0007) was observed in the prehabilitation group. No significant difference in LOS (WMD -2.39 95% CI -4.86 to 0.08 I2 = 0%, p = 0.06) or change in 6MWT distance (WMD 9.06 95% CI -35.68, 53.81 I2 = 88%, p = 0.69) was observed. CONCLUSIONS: Prehabilitation can reduce overall and pulmonary morbidity following surgery and could be utilised routinely. The precise protocol of prehabilitation has not been completely established. Further work is required to tailor optimal prehabilitation protocols for specific operative procedures.


Assuntos
Abdome/cirurgia , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/métodos , Humanos , Tempo de Internação , Condicionamento Físico Humano , Período Pós-Operatório , Ensaios Clínicos Controlados Aleatórios como Assunto , Teste de Caminhada
8.
Gastroenterology ; 149(7): 1896-1909.e14, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26344055

RESUMO

BACKGROUND & AIMS: Liver regeneration requires functional liver macrophages, which provide an immune barrier that is compromised after liver injury. The numbers of liver macrophages are controlled by macrophage colony-stimulating factor (CSF1). We examined the prognostic significance of the serum level of CSF1 in patients with acute liver injury and studied its effects in mice. METHODS: We measured levels of CSF1 in serum samples collected from 55 patients who underwent partial hepatectomy at the Royal Infirmary Edinburgh between December 2012 and October 2013, as well as from 78 patients with acetaminophen-induced acute liver failure admitted to the Royal Infirmary Edinburgh or the University of Kansas Medical Centre. We studied the effects of increased levels of CSF1 in uninjured mice that express wild-type CSF1 receptor or a constitutive or inducible CSF1-receptor reporter, as well as in chemokine receptor 2 (Ccr2)-/- mice; we performed fate-tracing experiments using bone marrow chimeras. We administered CSF1-Fc (fragment, crystallizable) to mice after partial hepatectomy and acetaminophen intoxication, and measured regenerative parameters and innate immunity by clearance of fluorescent microbeads and bacterial particles. RESULTS: Serum levels of CSF1 increased in patients undergoing liver surgery in proportion to the extent of liver resected. In patients with acetaminophen-induced acute liver failure, a low serum level of CSF1 was associated with increased mortality. In mice, administration of CSF1-Fc promoted hepatic macrophage accumulation via proliferation of resident macrophages and recruitment of monocytes. CSF1-Fc also promoted transdifferentiation of infiltrating monocytes into cells with a hepatic macrophage phenotype. CSF1-Fc increased innate immunity in mice after partial hepatectomy or acetaminophen-induced injury, with resident hepatic macrophage as the main effector cells. CONCLUSIONS: Serum CSF1 appears to be a prognostic marker for patients with acute liver injury. CSF1 might be developed as a therapeutic agent to restore innate immune function after liver injury.


Assuntos
Transdiferenciação Celular , Fatores Estimuladores de Colônias , Animais , Humanos , Imunidade Inata , Fígado/efeitos dos fármacos , Falência Hepática Aguda/imunologia , Macrófagos/imunologia , Camundongos , Camundongos Endogâmicos C57BL
10.
HPB (Oxford) ; 18(2): 177-182, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26902137

RESUMO

INTRODUCTION: Enhanced Recovery After Surgery protocols have been implemented effectively after liver resection and provide benefits in terms of general morbidity rates. In order to optimise peri-operative care protocols and minimise morbidity, further investigation is required to identify factors associated with poor outcome after liver resection. METHODS: A retrospective analysis of patients undergoing liver resection and enhanced recovery care between January 2006 and September 2012 was conducted. Data were collected on patient outcome and demographics, operative and pathological details. Univariate and multivariate analyses were performed to determine independent predictors of adverse outcome. RESULTS: 603 patients underwent liver resection during the study period. Morbidity and mortality rates were 34.3% and 1.5% respectively. The only predictor of major morbidity was extended resection (OR 4.079; 95% CI 2.177-7.642). CONCLUSIONS: Extended resection is associated with major morbidity. When determining optimum peri-operative care, ERAS protocols must incorporate care components that can mitigate against morbidity associated with extended resection.


Assuntos
Hepatectomia/reabilitação , Neoplasias Hepáticas/cirurgia , Cuidados Pós-Operatórios/métodos , Adulto , Idoso , Distribuição de Qui-Quadrado , Feminino , Hepatectomia/efeitos adversos , Humanos , Neoplasias Hepáticas/diagnóstico , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Cuidados Pós-Operatórios/efeitos adversos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
HPB (Oxford) ; 17(10): 863-71, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26292655

RESUMO

BACKGROUND: A liver resection under low central venous pressure (CVP) has become standard practice; however, the benefits beyond a reduction in blood loss are not well reported. Moreover, the precise method to achieve CVP reduction has not been established. A systematic review and meta-analysis of randomized controlled trials (RTCs) was performed to assess the effects of CVP on clinical outcome and to identify the optimum method of CVP reduction. METHODS: EMBASE, Medline, PubMed and the Cochrane database were searched for trials comparing low CVP surgery with controls. The primary outcome was post-operative complications within 30 days. Secondary outcomes included estimated blood loss (EBL), blood transfusion rates and length of stay (LOS). Sub-group analysis was performed to assess the CVP reduction method on the outcome. RESULTS: Eight trials were identified. No difference was observed in the morbidity rate between the high CVP and control groups [odds ratio (OR) = 0.96 (95% confidence interval (CI) 0.66, 1.40) P = 0.84, I(2) = 0%]. EBL [weighted mean difference (WMD) = -308.63 ml (95% CI -474.67, -142.58) P = < 0.001, I(2) = 73%] and blood transfusion rates [OR 0.65 (95% CI 0.44, 0.97) P = 0.040, I(2) = 37%] were significantly lower in the low CVP groups. Neither anaesthetic nor surgical methods of CVP reduction were associated with a reduced post-operative morbidity. CONCLUSION: Low CVP surgery is associated with a reduction in EBL; however, this does not translate into an improvement in post-operative morbidity. The optimum method of CVP reduction has not been identified.


Assuntos
Perda Sanguínea Cirúrgica/fisiopatologia , Pressão Venosa Central/fisiologia , Hepatectomia/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Humanos , Hipotensão Controlada/métodos
12.
HPB (Oxford) ; 16(8): 699-706, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24661306

RESUMO

BACKGROUND: Enhanced recovery after surgery (ERAS) programmes aim to improve postoperative outcomes. They are being utilized increasingly in hepatic surgery. This review aims to evaluate the impact of ERAS programmes on outcomes following liver surgery. METHODS: EMBASE, MEDLINE, PubMed and the Cochrane Database were searched for trials comparing outcomes in patients undergoing liver surgery utilizing ERAS principles with those in patients receiving conventional care. The primary outcome was occurrence of postoperative complications within 30 days. Secondary outcomes included length of stay (LoS), functional recovery and adherence to ERAS protocols. RESULTS: Nine articles were included in the review, of which two were randomized controlled trials (RCTs). Overall complication rates were 25.0% (range: 11.5-46.4%) in ERAS patients, and 31.0% (range: 11.8-46.2%) in conventional care patients. Significantly reduced overall complication rates following ERAS care were demonstrated by a meta-analysis of the data reported in the two RCTs (odds ratio: 0.49, 95% confidence interval 0.28-0.84; P = 0.01) The median LoS reported by the studies was 5.0 days (range: 2.5-7.0 days) in ERAS patients, and 7.5 days (range: 3.0-11.0 days) in non-ERAS patients. Recovery milestones, when reported, were improved following ERAS care. CONCLUSIONS: The adoption of ERAS protocols improves morbidity and LoS following liver surgery. Future ERAS programmes should accommodate the unique requirements of liver surgery in order to optimize postoperative outcomes.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Hepatopatias/cirurgia , Cuidados Pós-Operatórios , Distribuição de Qui-Quadrado , Protocolos Clínicos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Humanos , Tempo de Internação , Razão de Chances , Cuidados Pós-Operatórios/efeitos adversos , Complicações Pós-Operatórias/etiologia , Recuperação de Função Fisiológica , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
Br J Pharmacol ; 179(9): 1790-1807, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34826882

RESUMO

Lung diseases disproportionately affect elderly individuals. The lungs form a unique environment: a highly elastic organ with gaseous exchange requiring the closest proximity of inhaled air containing harmful agents and the circulating blood. The lungs are highly susceptible to senescence, with age and 'inflammageing' creating a pro-inflammatory environment with a reduced capacity to deal with challenges. While lung diseases may have disparate causes, the burden of ageing and inflammation provides a common process that can exacerbate seemingly unrelated pathologies. However, these shared pathways may also provide a common route to treatment, with increased interest in drugs that target ageing processes across respiratory diseases. In this review, we will examine the evidence for the increased burden of lung disease in older adults, the structural and functional changes seen with advancing age and assess what our expanding knowledge of inflammation and ageing pathways could mean for the treatment of lung disease. LINKED ARTICLES: This article is part of a themed issue on Inflammation, Repair and Ageing. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v179.9/issuetoc.


Assuntos
Envelhecimento , Inflamação , Idoso , Humanos , Inflamação/tratamento farmacológico , Pulmão
14.
Cells ; 11(18)2022 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-36139476

RESUMO

Rationale: Infection with the SARS-CoV2 virus is associated with elevated neutrophil counts. Evidence of neutrophil dysfunction in COVID-19 is based on transcriptomics or single functional assays. Cell functions are interwoven pathways, and understanding the effect across the spectrum of neutrophil function may identify therapeutic targets. Objectives: Examine neutrophil phenotype and function in 41 hospitalised, non-ICU COVID-19 patients versus 23 age-matched controls (AMC) and 26 community acquired pneumonia patients (CAP). Methods: Isolated neutrophils underwent ex vivo analyses for migration, bacterial phagocytosis, ROS generation, NETosis and receptor expression. Circulating DNAse 1 activity, levels of cfDNA, MPO, VEGF, IL-6 and sTNFRI were measured and correlated to clinical outcome. Serial sampling on day three to five post hospitalization were also measured. The effect of ex vivo PI3K inhibition was measured in a further cohort of 18 COVID-19 patients. Results: Compared to AMC and CAP, COVID-19 neutrophils demonstrated elevated transmigration (p = 0.0397) and NETosis (p = 0.0332), and impaired phagocytosis (p = 0.0036) associated with impaired ROS generation (p < 0.0001). The percentage of CD54+ neutrophils (p < 0.001) was significantly increased, while surface expression of CD11b (p = 0.0014) and PD-L1 (p = 0.006) were significantly decreased in COVID-19. COVID-19 and CAP patients showed increased systemic markers of NETosis including increased cfDNA (p = 0.0396) and impaired DNAse activity (p < 0.0001). The ex vivo inhibition of PI3K γ and δ reduced NET release by COVID-19 neutrophils (p = 0.0129). Conclusions: COVID-19 is associated with neutrophil dysfunction across all main effector functions, with altered phenotype, elevated migration and NETosis, and impaired antimicrobial responses. These changes highlight that targeting neutrophil function may help modulate COVID-19 severity.


Assuntos
COVID-19 , Neutrófilos , Antígeno B7-H1 , COVID-19/imunologia , Ácidos Nucleicos Livres , Desoxirribonucleases , Humanos , Interleucina-6/farmacologia , Neutrófilos/citologia , Fenótipo , Fosfatidilinositol 3-Quinases , Espécies Reativas de Oxigênio/metabolismo , SARS-CoV-2
15.
Front Immunol ; 12: 704173, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34367163

RESUMO

Infection and inflammation of the lung results in the recruitment of non-resident immune cells, including neutrophils, eosinophils and monocytes. This swift response should ensure clearance of the threat and resolution of stimuli which drive inflammation. However, once the threat is subdued this influx of immune cells should be followed by clearance of recruited cells through apoptosis and subsequent efferocytosis, expectoration or retrograde migration back into the circulation. This cycle of cell recruitment, containment of threat and then clearance of immune cells and repair is held in exquisite balance to limit host damage. Advanced age is often associated with detrimental changes to the balance described above. Cellular functions are altered including a reduced ability to traffic accurately towards inflammation, a reduced ability to clear pathogens and sustained inflammation. These changes, seen with age, are heightened in lung disease, and most chronic and acute lung diseases are associated with an exaggerated influx of immune cells, such as neutrophils, to the airways as well as considerable inflammation. Indeed, across many lung diseases, pathogenesis and progression has been associated with the sustained presence of trafficking cells, with examples including chronic diseases such as Chronic Obstructive Pulmonary Disease and Idiopathic Pulmonary Fibrosis and acute infections such as Pneumonia and Pneumonitis. In these instances, there is evidence that dysfunctional and sustained recruitment of cells to the airways not only increases host damage but impairs the hosts ability to effectively respond to microbial invasion. Targeting leukocyte migration in these instances, to normalise cellular responses, has therapeutic promise. In this review we discuss the current evidence to support the trafficking cell as an immunotherapeutic target in lung disease, and which potential mechanisms or pathways have shown promise in early drug trials, with a focus on the neutrophil, as the quintessential trafficking immune cell.


Assuntos
Movimento Celular/imunologia , Citocinas/imunologia , Pulmão/imunologia , Neutrófilos/imunologia , Pneumonia/imunologia , Doença Pulmonar Obstrutiva Crônica/imunologia , Animais , Humanos , Inflamação/imunologia
16.
Open Forum Infect Dis ; 8(12): ofab572, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34917695

RESUMO

Cases of extensively drug-resistant (XDR) typhoid fever have been reported in the United States among patients who did not travel internationally. Clinicians should consider if and where the patient traveled when selecting empiric treatment for typhoid fever. XDR typhoid fever should be treated with a carbapenem, azithromycin, or both.

17.
JAMA Netw Open ; 4(9): e2125203, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34524434

RESUMO

Importance: Extensively drug-resistant Campylobacter jejuni infections cannot be treated with any commonly recommended antibiotics and pose an increasing public health threat. Objectives: To investigate cases of extensively drug-resistant C jejuni associated with pet store puppies and describe the epidemiologic and laboratory characteristics of these infections. Design, Setting, and Participants: In August 2017, health officials identified, via survey, patients with C jejuni infections who reported contact with puppies sold by pet stores. In conjunction with state and federal partners, the Centers for Disease Control and Prevention investigated cases of culture-confirmed C jejuni infections in US patients with an epidemiologic or molecular association with pet store puppies between January 1, 2016, and February 29, 2020. Available records from cases occurring before 2016 with genetically related isolates were also obtained. Main Outcomes and Measures: Patients were interviewed about demographic characteristics, health outcomes, and dog exposure during the 7 days before illness onset. Core genome multilocus sequence typing was used to assess isolate relatedness, and genomes were screened for resistance determinants to predict antibiotic resistance. Isolates resistant to fluoroquinolones, macrolides, and 3 or more additional antibiotic classes were considered to be extensively drug resistant. Cases before 2016 were identified by screening all sequenced isolates submitted for surveillance using core genome multilocus sequence typing. Results: A total of 168 patients (median [interquartile range] age, 37 [19.5-51.0] years; 105 of 163 female [64%]) with an epidemiologic or molecular association with pet store puppies were studied. A total of 137 cases occurred from January 1, 2016, to February 29, 2020, with 31 additional cases dating back to 2011. Overall, 117 of 121 patients (97%) reported contact with a dog in the week before symptom onset, of whom 69 of 78 (88%) with additional information reported contact with a pet store puppy; 168 isolates (88%) were extensively drug resistant. Traceback investigation did not implicate any particular breeder, transporter, distributer, store, or chain. Conclusions and Relevance: Strains of extensively drug-resistant C jejuni have been circulating since at least 2011 and are associated with illness among pet store customers, employees, and others who come into contact with pet store puppies. The results of this study suggest that practitioners should ask about puppy exposure when treating patients with Campylobacter infection, especially when they do not improve with routine antibiotics, and that the commercial dog industry should take action to help prevent the spread of extensively drug-resistant C jejuni from pet store puppies to people.


Assuntos
Zoonoses Bacterianas/epidemiologia , Infecções por Campylobacter/epidemiologia , Campylobacter jejuni , Surtos de Doenças , Doenças do Cão/transmissão , Animais de Estimação , Adulto , Animais , Infecções por Campylobacter/microbiologia , Infecções por Campylobacter/veterinária , Cães , Farmacorresistência Bacteriana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia
18.
Inorg Chem ; 49(1): 271-84, 2010 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-19950895

RESUMO

The salt, [OsO(2)F(3)][Sb(2)F(11)], has been synthesized by dissolution of cis-OsO(2)F(4) in liquid SbF(5), followed by removal of excess SbF(5) at 0 degrees C to yield orange, crystalline [OsO(2)F(3)][Sb(2)F(11)]. The X-ray crystal structure (-173 degrees C) consists of an OsO(2)F(3)(+) cation fluorine bridged to an Sb(2)F(11)(-) anion. The light atoms of OsO(2)F(3)(+) and the bridging fluorine atom form a distorted octahedron around osmium in which the osmium atom is displaced from its center toward an oxygen atom and away from the trans-fluorine bridge atom. As in other transition metal dioxofluorides, the oxygen ligands are cis to one another and the fluorine bridge atom is trans to an oxygen ligand and cis to the remaining oxygen ligand. The Raman spectrum (-150 degrees C) of solid [OsO(2)F(3)][Sb(2)F(11)] was assigned on the basis of the ion pair observed in the low-temperature crystal structure. Under dynamic vacuum, [OsO(2)F(3)][Sb(2)F(11)] loses SbF(5), yielding the known [mu-F(OsO(2)F(3))(2)][Sb(2)F(11)] salt with no evidence for [OsO(2)F(3)][SbF(6)] formation. Attempts to synthesize [OsO(2)F(3)][SbF(6)] by the reaction of [OsO(2)F(3)][Sb(2)F(11)] with an equimolar amount of cis-OsO(2)F(4) or by a 1:1 stoichiometric reaction of cis-OsO(2)F(4) with SbF(5) in anhydrous HF yielded only [mu-F(OsO(2)F(3))(2)][Sb(2)F(11)]. Quantum-chemical calculations at the SVWN and B3LYP levels of theory and natural bond orbital analyses were used to calculate the gas-phase geometries, vibrational frequencies, natural population analysis charges, bond orders, and valencies of OsO(2)F(3)(+), [OsO(2)F(3)][Sb(2)F(11)], [OsO(2)F(3)][SbF(6)], and Sb(2)F(11)(-). The relative thermochemical stabilities of [OsO(2)F(3)][SbF(6)], [OsO(2)F(3)][Sb(2)F(11)], [OsO(2)F(3)][AsF(6)], [mu-F(OsO(2)F(3))(2)][SbF(6)], [mu-F(OsO(2)F(3))(2)][Sb(2)F(11)], and [mu-F(OsO(2)F(3))(2)][AsF(6)] were assessed using the appropriate Born-Haber cycles to account for the preference for [mu-F(OsO(2)F(3))(2)][Sb(2)F(11)] formation over [OsO(2)F(3)][SbF(6)] formation and for the inability to synthesize [OsO(2)F(3)][SbF(6)].

19.
Inorg Chem ; 49(7): 3501-15, 2010 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-20184317

RESUMO

Stoichiometric amounts of XeF(6) and (OsO(3)F(2))(infinity) react at 25-50 degrees C to form salts of the known XeF(5)(+) and Xe(2)F(11)(+) cations, namely, [XeF(5)][mu-F(OsO(3)F(2))(2)], [XeF(5)][OsO(3)F(3)], and [Xe(2)F(11)][OsO(3)F(3)]. Although XeF(6) is oxophilic toward a number of transition metal and main-group oxides and oxide fluorides, fluoride/oxide metathesis was not observed. The series provides the first examples of noble-gas cations that are stabilized by metal oxide fluoride anions and the first example of a mu-F(OsO(3)F(2))(2)(-) salt. Both [XeF(5)][mu-F(OsO(3)F(2))(2)] and [Xe(2)F(11)][OsO(3)F(3)] are orange solids at room temperature. The [XeF(5)][OsO(3)F(3)] salt is an orange liquid at room temperature that solidifies at 5-0 degrees C. When the salts are heated at 50 degrees C under 1 atm of N(2) for more than 2 h, significant XeF(6) loss occurs. The X-ray crystal structures (-173 degrees C) show that the salts exist as discrete ion pairs and that the osmium coordination spheres in OsO(3)F(3)(-) and mu-F(OsO(3)F(2))(2)(-) are pseudo-octahedral OsO(3)F(3)-units having facial arrangements of oxygen and fluorine atoms. The mu-F(OsO(3)F(2))(2)(-) anion is comprised of two symmetry-related OsO(3)F(2)-groups that are fluorine-bridged to one another. Ion pairing results from secondary bonding interactions between the fluorine/oxygen atoms of the anions and the xenon atom of the cation, with the Xe...F/O contacts occurring opposite the axial fluorine and from beneath the equatorial XeF(4)-planes of the XeF(5)(+) and Xe(2)F(11)(+) cations so as to avoid the free valence electron lone pairs of the xenon atoms. The xenon atoms of [XeF(5)][mu-F(OsO(3)F(2))(2)] and [Xe(2)F(11)][OsO(3)F(3)] are nine-coordinate and the xenon atom of [XeF(5)][OsO(3)F(3)] is eight-coordinate. Quantum-chemical calculations at SVWN and B3LYP levels of theory were used to obtain the gas-phase geometries, vibrational frequencies, and NBO bond orders, valencies, and NPA charges of the ion pairs, [Xe(2)F(11)][OsO(3)F(3)], [XeF(5)][OsO(3)F(3)], and [XeF(5)][mu-F(OsO(3)F(2))(2)], as well as those of the free ions, Xe(2)F(11)(+), XeF(5)(+), OsO(3)F(3)(-), and mu-F(OsO(3)F(2))(2)(-). The Raman spectra (-150 degrees C) of the salts have been assigned based on the ion pairs observed in the crystal structures and the calculated vibrational frequencies and intensities of the gas-phase ion pairs.

20.
Inorg Chem ; 49(11): 4768-80, 2010 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-20384313

RESUMO

Dissolution of the infinite chain polymer, (OsO(3)F(2))(infinity), in CH(3)CN solvent at -40 degrees C followed by solvent removal under vacuum at -40 degrees C yielded fac-OsO(3)F(2)(NCCH(3)).nCH(3)CN (n >/= 2). Continued pumping at -40 degrees C with removal of uncoordinated CH(3)CN yielded fac-OsO(3)F(2)(NCCH(3)). Both fac-OsO(3)F(2)(NCCH(3)).nCH(3)CN and fac-OsO(3)F(2)(NCCH(3)) are yellow-brown solids and were characterized by low-temperature (-150 degrees C) Raman spectroscopy. The crystal structure (-173 degrees C) of fac-OsO(3)F(2)(NCCH(3)).2CH(3)CN consists of two co-crystallized CH(3)CN molecules and a pseudo-octahedral OsO(3)F(2).NCCH(3) molecule in which three oxygen atoms are in a facial arrangement and CH(3)CN is coordinated trans to an oxygen atom in an end-on fashion. The Os---N bond length (2.205(3) A) is among the shortest M---N adduct bonds observed for a d(0) transition metal oxide fluoride. The (19)F NMR spectrum of (OsO(3)F(2))(infinity) in CH(3)CN solvent (-40 degrees C) is a singlet (-99.6 ppm) corresponding to fac-OsO(3)F(2)(NCCH(3)). The (1)H, (15)N, (13)C, and (19)F NMR spectra of (15)N-enriched OsO(3)F(2)(NCCH(3)) were recorded in SO(2)ClF solvent (-84 degrees C). Nitrogen-15 enrichment resulted in splitting of the (19)F resonance of fac-OsO(3)F(2)((15)NCCH(3)) into a doublet ((2)J((15)N-(19)F), 21 Hz). In addition, a doublet of doublets ((2)J((19)F(ax)-(19)F(eq)), 134 Hz; (2)J((15)N-(19)F(eq)), 18 Hz) and a doublet ((2)J((19)F(ax)-(19)F(eq)), 134 Hz) were observed in the (19)F NMR spectrum that have been assigned to mer-OsO(3)F(2)((15)NCCH(3)); however, coupling of (15)N to the axial fluorine-on-osmium environment could not be resolved. The nitrogen atom of CH(3)CN is coordinated trans to a fluorine ligand in the mer-isomer. Quantum-chemical calculations at the SVWN and B3LYP levels of theory were used to calculate the energy-minimized gas-phase geometries, vibrational frequencies of fac- and mer-OsO(3)F(2)(NCCH(3)) and of CH(3)CN. The relative stabilities of the mer- and fac-isomers have been determined and are in accordance with the solution NMR assignments.


Assuntos
Complexos de Coordenação/química , Complexos de Coordenação/síntese química , Compostos Organometálicos/química , Compostos Organometálicos/síntese química , Osmio/química , Cristalografia por Raios X , Espectroscopia de Ressonância Magnética , Modelos Moleculares , Análise Espectral Raman
SELEÇÃO DE REFERÊNCIAS
Detalhe da pesquisa