Two invasive group A streptococcus (iGAS) infection outbreaks occurred in Montreal in 2016 and 2017; one in a long-term care facility (type
118) and one in the community, primarily involving homeless ...people (type
74).
To describe two recent iGAS outbreaks in Montréal and highlight the challenges in dealing with these outbreaks and the need to tailor the public health response to control them.
All cases of iGAS were investigated and the isolates were sent to the laboratory for
typing. In both outbreaks, cases of superficial group A
(GAS) infection were identified, through 1) systematic case detection accompanied by screening for asymptomatic carriers among residents and employees of the long-term care facility and 2) sentinel surveillance among homeless people. Visits were made to community organizations providing homeless services (including shelters) and social networks were analyzed to establish whether there were any links among cases of GAS infection (both invasive and noninvasive) and locations frequented. In both outbreaks, recommendations were made to service providers regarding enhancement of infection prevention and control measures.
In the long-term care facility, five cases of type
118 iGAS were identified over a 22-month period, one of which resulted in death. All residents were screened and no carriers were identified. Among the employees, 81 (65%) were screened and fourcarriers were identified. Of those, one was a carrier of type
118 GAS. All carriers were treated, and subsequent follow-up sampling on three carriers (including the one with
118) was negative.In the community, 23 cases of type
74 iGAS were detected over a 16-month period, four of which resulted in death. Half of the cases (n=12) were described as homeless, and six others were users of services for the homeless. Sentinel surveillance of superficial infections yielded 64 cultures with GAS, chiefly on the skin, including 51 (80%) of type
74. An analysis of the social networks revealed the large number and variety of resources for the homeless used by the cases. Visits to the community organizations providing homeless services revealed the heterogeneity and precariousness of some of these services, the difficulties encountered in applying adequate health and hygiene measures, and the high degree of mobility amongst those who use these services.
The detection and control of iGAS outbreaks in both long-term care establishments and among community organizations providing homeless services are very complex. An outbreak of iGAS can develop in the background over a long time and be easily overlooked despite cases being admitted to the hospital.
typing and systematic research of previous cases of iGAS are essential tools for the detection and characterization of outbreaks. Close cooperation among public health agencies, clinical teams, community organizations and laboratories is essential for proper monitoring and the reduction of GAS transmission in the community and health care settings.
Treatment of read canary grass leaves with phenol, 4-chlorophenol, naphthalic anhydride and phenylethylisothiocyanate increased glutathione S-transferase activity by 1.4-2.4-fold (control 17 U g^sup ...-1^ DW). Benzothiadiazole, β-aminobutyric acid and salicylic acid increased activity by 1.3-1.8-fold. Total glutathione pool was increased by the toxic compounds by 1.2-2-fold and by the elicitors 1.4-1.6-fold (control 593 nmol g^sup -1^ DW). Unlike the other compounds, benzothiadiazole and salicylic acid did not decrease the redox state. Benzothiadiazole acted synergistically with chlorophenol on glutathione S-transferase and glutathione levels and counteracted the decrease in redox state caused by the xenobiotic. Reed canary grass thus has a strong potential to neutralize toxic compounds, which may be further enhanced by elicitors.PUBLICATION ABSTRACT
On behalf of the International Test Commission and the European Federation of Psychologists' Associations a world-wide survey on the opinions of professional psychologists on testing practices was ...carried out. The main objective of this study was to collect data for a better understanding of the state of psychological testing worldwide. These data could guide the actions and measures taken by ITC, EFPA, and other stakeholders. A questionnaire was administered to 20,467 professional psychologists from 29 countries. Five scales were constructed relating to: concern over incorrect test use, regulations on tests and testing, internet and computerized testing, appreciation of tests, and knowledge and training relating to test use. Equivalence across countries was evaluated using the alignment method, four scales demonstrated acceptable levels of invariance. Multilevel analysis was used to determine how scores were related to age, gender, and specialization, as well as how scores varied between countries. Although the results show a high appreciation of tests in general, the appreciation of internet and computerized testing is much lower. These scales show low variability over countries, whereas differences between countries on the other reported scales are much greater. This implies the need for some overarching improvements as well as country-specific actions.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background Parenteral administration is the main route of drug administration in intensive care unit patients. To maintain high level of treatment efficacy and safety, precise preparation of ...parenteral infusions is necessary, since non-homogeneous drug dissolution may affect the quality of continuous infusion therapy.
The purpose of this study was to evaluate the diagnostic value of MRI for detecting intracarpal lesions in clinical routine.
In a retrospective study, we reviewed the charts of 506 patients who had ...undergone wrist arthroscopy in our department between May 1998 and November 2002. Out of 506 patients 217 had an MRI. The MRI was performed at 31 different radiology facilities using a number of techniques. The MRI results were compared with the arthroscopic findings, taking the arthroscopic results as a "gold standard" (sensitivity = SEN, specificity = SPE, positive predictive value = PPV, negative predictive value = NPV, accuracy = ACC).
The following results were found: For tears of the scapholunate ligament the avalues are SEN 18.5 %, SPE 95 %, PPV 71 %, NPV 66 %, ACC66 %. Not one of 16 tears of the lunotriquetral ligament was found by MRI.
In our data we found a low sensitivity for unspecific requested and implemented MRI for detecting intracarpal lesions. Therefore the indication for MRI should only be made after experienced hand surgeons have examined the wrist. In our opinion, only direct MR-arthrography is equal to arthroscopy, so that only an experienced radiologist who is familiar with this technique should perform the MRI diagnostics of the hand.
A sudden increase in
Thompson (
. Thompson) cases distributed throughout three border regions in the province of Quebec in November 2016 triggered a provincial investigation to identify a common ...source of contamination and to put the appropriate control measures into place.
To report on the outbreak and to describe the use of genomic sequencing to identify the salmonella serotype responsible.
A descriptive survey of all reported cases of
serogroup C1 that had occurred between October 1, 2016 and February 15, 2017 was conducted. A case definition was developed. Pulsed field gel electrophoresis supplemented by analyses of genome sequences using the single nucleotide variant phylogenomics method were used to demarcate and manage the outbreak.
Eighteen cases of
Thompson were identified through whole genome sequencing. The onset dates of symptoms for the 16 cases that presented enteric symptoms were November 21-December 2, 2016. Two cases that presented with atypical symptoms were not reported until February 2017. Among the 18 cases, 16 had eaten or probably eaten chicken shawarma at the same restaurant chain and nine of these cases ate it at the same restaurant. In total, five restaurants from this chain, spread throughout three border regions of Quebec, were identified.
Outbreaks associated with chicken shawarma have been identified in the past. Efforts must be made to ensure that the owners of this type of restaurant know the contamination risk associated with this type of cooking and take the necessary steps to reduce this risk. The use of the genome sequencing method was very useful in defining the outbreak.
Protease inhibitors for the treatment of HCV can cause mild and reversible elevations of unconjugated bilirubin. We sought to characterize genetic determinants of bilirubin elevations using a ...genome-wide approach among patients with genotype 1 HCV who received combination therapy that included GS-9256, a novel potent inhibitor of HCV NS3 serine protease, as part of a Phase IIb trial.
Of the 200 patients sampled, 176 had confirmed European ancestry and were included in the analysis. Infinium HumanOmni5BeadChip (Illumina, Inc., San Diego, CA, USA) was used for genotyping. A categorical analysis of low (grade 0-1) versus high (grade 2-4) bilirubin toxicity grade and a quantitative trait locus mapping of peak bilirubin concentrations was performed.
A total of 4,466,809 genetic markers were analysed. No single variant showed a statistically significant association with observed bilirubin elevations in this patient population. In a targeted analysis of single nucleotide polymorphisms in genes known to be involved in bilirubin transport, no significant differences in allele frequency between high and low bilirubin toxicity grade were observed.
These results indicate that risk for bilirubin elevation in patients receiving GS-9256 is unlikely to be strongly influenced by common genetic variants with large effects. The current study cannot rule out a role for common variants of weak effect, or a more complex model, including multiple contributing factors, such as rare variants and as yet unidentified environmental influences.
Objectives:
Cerebral air microembolisation (CAM) represents a typical complication after open heart surgery, diagnostic and therapeutic angiography, neurosurgery and diving. Massive CAM is a rare ...condition and typically results in severe brain damage. Subtle CAM, however, is a very frequent side-effect i.e. of open cardiac surgery or angiography and can lead to faint but persistent neuropsychological deficits. The pathophysiological background of brain damage caused by subtle CAM is largely unknown.
Filter systems have been suggested to reduce the amount of gaseous cerebral emboli. However, many filter types lead to a dispersion of large gas bubbles into numerous smaller particles and therefore exponentially increase the total bubble surface, which might increase potentially hazardous gas-endothelium contact.
Thus, the present animal study was conducted to determine the impact of air bubble size on neurological outcome after CAM.
Methods:
Gas microemboli of precisely defined number and diameter were injected into the carotid artery of rats.
Wistar rats were randomised into 3 groups: Group I (n=6) received 1800 air bubbles of 45µm, group II received 40 bubbles of 160µm in diameter, resulting in identical total air volume (86µl) in both groups. Group III (n=5) received saline without gas bubbles. Functional outcome was assessed after 4h and 24h and 7T-MRI was carried out after 24h.
Results:
The actual bubble size was 45.8µm±2.8 in group 1 and 159.0µm±1.3 in group 2. The effective bubble count amounted to 1808±11 in group I and 40±0.4 in Group II.
Animals of group I and II suffered infarcts and deteriorated clinically without any significant difference between both groups. The neurological score was 15±11.8 after 4h and 10±5.5 after 24h in group I and 19.2±11.1 after 4h and 19±10.2 after 24h in group II.
Mean infarct size was likewise comparable in both groups without any significant difference (group I: 10.0%±14.5; group II: 5.4.%±6.1; p=0.53). In the sham infusion group no pathological findings were detectable.
Conclusion:
In this animal model neurological side effects of CAM depend on the total volume of embolised air but not on the size of the air bubbles. These results may have further impact for clinical protection of cerebral air microembolisation.
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