ABSTRACT
From 2011 through 2018, there was a notable increase in sporadic Legionnaires' disease in the state of Minnesota. Sporadic cases are those not associated with a documented outbreak. Outbreak-related cases are typically associated with a common identified contaminated water system; sporadic cases typically do not have a common source that has been identified. Because of this, it is hypothesised that weather and environmental factors can be used as predictors of sporadic Legionnaires' disease. An ecological design was used with case report surveillance data from the state of Minnesota during 2011 through 2018. Over this 8-year period, there were 374 confirmed Legionnaires' disease cases included in the analysis. Precipitation, temperature and relative humidity (RH) data were collected from weather stations across the state. A Poisson regression analysis examined the risk of Legionnaires' disease associated with precipitation, temperature, RH, land-use and age. A lagged average 14-day precipitation had the strongest association with Legionnaires' disease (RR 2.5, CI 2.1-2.9), when accounting for temperature, RH, land-use and age. Temperature, RH and land-use also had statistically significant associations to Legionnaires' disease, but with smaller risk ratios. This study adds to the body of evidence that weather and environmental factors play an important role in the risk of sporadic Legionnaires' disease. This is an area that can be used to target additional research and prevention strategies.
Subject(s)
Legionnaires' Disease/epidemiology , Legionnaires' Disease/etiology , Weather , Adult , Aged , Disease Outbreaks , Female , Humans , Male , Middle Aged , Minnesota/epidemiology , Retrospective Studies , Water Microbiology , Young AdultSubject(s)
Diabetic Nephropathies/mortality , Heart Ventricles/physiopathology , Kidney Diseases/mortality , Adolescent , Adult , Cardiac Catheterization , Coronary Disease/diagnostic imaging , Coronary Disease/physiopathology , Diabetes Mellitus, Type 1/complications , Diabetic Nephropathies/physiopathology , Heart Ventricles/diagnostic imaging , Humans , Kidney Diseases/etiology , Kidney Diseases/physiopathology , Pressure , Prognosis , Prospective Studies , RadiographyABSTRACT
This study suggests that 1) cerebral atrophy is present in end-stage uremia; 2) the degree of atrophy correlates best with the age of onset of end-stage uremia and is most marked during the ages of cerebral development, but is also present in adults. Further studies will be needed to elucidate causative factor(s) and the degree of cerebral functional impairment, if any.
Subject(s)
Brain Diseases/etiology , Brain/pathology , Uremia/complications , Adolescent , Adult , Age Factors , Aged , Atrophy/etiology , Brain/diagnostic imaging , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Renal Dialysis , Tomography, X-Ray Computed , Uremia/pathologyABSTRACT
The mechanism perpetuating hypocalcemia in the presence of hypomagnesemia is unknown. Two patients with this disorder had elevated immunoreactive serum parathyroid hormone levels and incomplete distal renal tubular acidosis. All abnormalities were corrected with magnesium replenishment. Postulated mechanisms include (1) parathyroid hormone activation in the serum or at the site of action dependent on magnesium, and (2) abnormalities in vitamin D metabolism that can be corrected by magnesium replacement.