[Comparison of the NINDS-AIREN and VASCOG criteria for the diagnosis of major vascular cognitive impairment in a memory clinic]. / Comparacion de los criterios NINDS-AIREN y VASCOG para el diagnostico de deterioro cognitivo vascular mayor en una clinica de memoria.

INTRODUCTION: Major vascular cognitive impairment has a high prevalence in elder population over 60 years old. Its diagnosis is complex, and there are multiple criteria with a high degree of heterogeneity between them. Validation studies of the VASCOG criteria are required, and comparison with the other groups of criteria available for the diagnosis of major vascular cognitive impairment. AIM: To compare NINDS-AIREN and VASCOG criteria to diagnose major vascular cognitive impairment in a memory clinic. PATIENTS AND METHODS: An analytical transversal observational study was performed in elder adults who attended to university memory clinic for one year. Clinical records of patients were collected, verifying inclusion and exclusion criteria by applying NINDS-AIREN and VASCOG criteria. Subsequently cerebral magnetic resonance imaging results were assessed and yet again defined criteria were applied. RESULTS: Major vascular cognitive impairment diagnosis rate was greater by applying VASCOG criteria. Concordance between NINDS-AIREN and VASCOG criteria was very high (100%), with a substantial consistence level (kappa = 0.698) for a final diagnosis. Before performing a magnetic resonance imaging, concordance level was reduced (55.6%) with a substantial consistence level (kappa = 0.620). CONCLUSIONS: NINDS-AIREN and VASCOG criteria have a high consistence level for major vascular cognitive impairment diagnosis, with a moderate concordance level in clinical criteria, to different assessed domains. Depending on criteria used, diagnosis prevalence changes, being higher with VASCOG criteria.

TITLE: Comparacion de los criterios NINDS-AIREN y VASCOG para el diagnostico de deterioro cognitivo vascular mayor en una clinica de memoria.Introduccion. El deterioro cognitivo vascular mayor tiene una alta prevalencia en la poblacion mayor de 60 años. El diagnostico es complejo y existen multiples criterios con alto grado de heterogeneidad entre ellos. Se requieren estudios de validacion de los criterios VASCOG y la comparacion con los otros grupos de criterios disponibles para el diagnostico de deterioro cognitivo vascular mayor. Objetivo. Comparar los criterios NINDS-AIREN y VASCOG para el diagnostico de deterioro cognitivo vascular mayor en una clinica de memoria. Pacientes y metodos. Se realizo un estudio descriptivo observacional de corte transversal analitico en adultos mayores que asistieron a una clinica de memoria universitaria durante un año. Se recopilo la historia clinica de los pacientes, se verificaron los criterios de inclusion y exclusion y se aplicaron los criterios NINDS-AIREN y VASCOG. Posteriormente se evaluaron los resultados de la resonancia magnetica cerebral y se aplicaron nuevamente los criterios definidos. Resultados. La frecuencia de diagnostico de deterioro cognitivo vascular mayor fue mayor utilizando los criterios VASCOG. La concordancia entre los criterios NINDS-AIREN y VASCOG fue muy alta (100%), con un nivel de consistencia sustancial (kappa = 0,698) para un diagnostico definitivo. Antes de realizar la resonancia, el nivel de concordancia se redujo (55,6%), con un nivel de consistencia sustancial (kappa = 0,620). Conclusiones. Los criterios NINDS-AIREN y VASCOG tienen un alto nivel de consistencia para el diagnostico de deterioro cognitivo vascular mayor, con un nivel moderado de concordancia en los criterios clinicos. Dependiendo de los criterios utilizados, la prevalencia de diagnostico cambia y es mayor para los criterios VASCOG.

Eficacia y seguridad de tres esquemas para la preparación del colon para colonoscopia (polietilenglicol (PEG) 4 litros (4 L) (dosis única) vs. PEG 4 L dividido (2 L + 2 L) vs. PEG 2 L dividido de volumen bajo (1 L + 1 L): ensayo clínico controlado aleatorizado / A randomized controlled clinical trial of the efficacy and safety of colonoscopy preparation using a single four liter dose of polyethylene glycol (PEG) vs. two 2 liter doses of PEG vs. two low volume (1L + 1L) doses of PEG

Resumen Introducción: la colonoscopia es el examen estándar de oro para evaluar la mucosa del colon. De la limpieza del colon en la preparación intestinal para colonoscopia depende el hallazgo de pólipos, que pueden ser adenomatosos con potencial maligno y con la posibilidad de degenerarse en cáncer de colon. Objetivo: comparar la eficacia y la seguridad de tres tipos de preparaciones para la limpieza del colon: dosis única de polietilenglicol (PEG) 4 litros (4 L) y dosis divididas: PEG 4 L dividido (2 L + 2 L) y PEG 2 L dividido (1 L + 1 L) de volumen bajo. Métodos: en pacientes con una colonoscopia electiva de una clínica universitaria, se realizó un ensayo clínico controlado aleatorizado y ciego (para el médico que evaluó la limpieza del colon). Se asignaron 74 pacientes para cada grupo. El parámetro principal de eficacia fue la preparación integral de calidad adecuada medida con la escala de Boston, y los parámetros secundarios fueron el porcentaje de eventos adversos, la tolerabilidad y la tasa de detección de pólipos. Resultados: la preparación completa de todo el colon fue significativamente de mayor la calidad en la alternativa de 4 L divididos (2 L + 2 L), seguida de la otra alternativa dividida (1 L + 1 L) y menor en la dosis única (79,7 %, 75,7 % y 63,5 %, respectivamente, p = 0,019); también se encontraron diferencias en la detección de pólipos (13,5 %, 24,3 % y 9,5 %, p = 0,037) y sin diferencias en la presentación de al menos un evento adverso (p = 0,254) ni en la tolerabilidad (p = 0,640). Conclusiones: las dos preparaciones de dosis dividida tienen una mayor eficacia en la limpieza del colon en comparación con la dosis única de 4 L y en la detección de pólipos, mientras que no se evidencian diferencias en las preparaciones para la ocurrencia de eventos adversos y la tolerabilidad. La dosis de PEG 2 L dividido puede ser una muy buena opción para las preparaciones de colonoscopia electiva.

Abstract Introduction: Colonoscopy is the gold standard for evaluation of the colonic mucosa. Colon cleansing in preparation for colonoscopy depends on finding of polyps which can be adenomatous with malignant potential and the possibility of degenerating into colon cancer. Objective: This study's objective was to compare the efficacy and safety of three types of preparations for colon cleansing: a single four liter dose of polyethylene glycol (PEG) vs. two 2 liter doses of PEG vs. two low volume (1L + 1L) doses of PEG. Methods: This is a randomized controlled clinical trial of patients who underwent elective colonoscopy at a University clinic. It was blinded for the doctor who evaluated colon cleansing. Seventy four patients 74 patients were randomized into each group. The main parameter of effectiveness was integral preparation of adequate quality measured on the Boston scale. Secondary parameters were the percentage of adverse events, tolerability and detection rate of polyps. Results: Complete preparation of the entire colon was achieved significantly more often with 4 liters divided into two 2 liter doses followed by the other divided alternative (1 L + 1 L). It was achieved least frequently with in the single dose: 79.7%, 75.7% and 63.5%, respectively, p = 0.019. Differences were also found in the detection of polyps (13.5%, 24.3% and 9.5%, respectively, p = 0.037). ) There were no differences in presentation of at least one adverse event (p = 0.254) or in tolerability (p = 0.640). Conclusions: The two divided dose preparations had higher colon cleansing and polyp detection efficacies than did the single 4L dose while there were no differences in occurrence of adverse events and tolerability. The divided PEG 2L dose could be a very good option for elective colonoscopy preparation.

Internalization and thermal susceptibility of Shiga toxin-producing Escherichia coli (STEC) in marinated beef products.

This study evaluated the internalization and cooking susceptibility of seven individual Escherichia coli (STEC) serogroups in surface-inoculated (10(5)log CFU/cm(2)) and vacuum tumbled marinated (30 or 60 min) bottom sirloin steaks. After storage for 14 days (0 to 2°C), flaps were cooked to various endpoint temperatures (55, 60, 65, and 71°C) for evaluation of pathogen survival by direct plating or rapid PCR based detection (BAX®). Direct plating of cooked samples yielded no enumerable plates. The data indicate varied internalization, translocation, and heat susceptibility patterns among serogroups. Using the rapid PCR based detection method O26, O103, and O111 were detected in flaps after cooking to 55 and 60°C, while O157:H7 survived in flaps cooked to 60 and 65°C. However, STEC O145 was the only serogroup that survived in all cooking temperatures. Serogroup O121 was not detected by plating or PCR in any cooked products. Intriguingly, STEC serogroups can be internalized during marination and the internalized pathogens vary in thermal susceptibility.

The influence of beef quality characteristics on the internalization and thermal susceptibility of Shiga toxin-producing Escherichia coli (STEC) in blade-tenderized beef steaks.

The risk of Shiga toxin-producing Escherichia coli (STEC) survival in blade-tenderized beef is a concern for beef processors. This study evaluated the internalization and post-cooking survival of individual STEC serogroups (O157:H7, O26, O45, O103, O111, O121, and O145) in blade-tenderized beef steaks with different quality traits. Strip loins representing four combinations of USDA Quality Grade (Choice or Select) and pH category (High pH or Normal pH) were inoculated (10(6)logCFU/cm(2) attachment) with individual STEC serogroups before storage (14 days), blade tenderization, and cooking (50, 60, 71, or 85°C). Serogroup populations on raw steak surfaces and internal cores were determined. Rapid-based methods were used to detect the internal presence of STEC in cooked steaks. Internalization and post-cooking survival varied among STECs. All serogroups, except O45 and O121, were detected in the internal cores of steaks cooked to 50°C, while O103, O111, and O145 STEC were detected in steaks cooked to 50, 60, and 71°C.

Survivability of Escherichia coli O157:H7 in mechanically tenderized beef steaks subjected to lactic acid application and cooking under simulated industry conditions.

Mechanical tenderization improves the palatability of beef; however, it increases the risk of translocating pathogenic bacteria to the interior of beef cuts. This study investigated the efficacies of lactic acid spray (LA; 5 % ), storage, and cooking on the survivability of Escherichia coli O157:H7 in mechanically tenderized beef steaks managed under simulated industry conditions. Beef subprimals inoculated with either high (10(5) CFU/ml) or low (10(3) CFU/ml) levels of E. coli O157:H7 were treated (LA or control) and stored for 21 days prior to mechanical tenderization, steak portioning (2.54 cm), and additional storage for 7 days. Steaks were then cooked to an internal temperature of 55, 60, 65, 70, or 75°C. Samples were enumerated and analyzed using DNA-based methods. Treatment with LA immediately reduced E. coli O157:H7 on the lean and fat surfaces of high- and low-inoculum-treated subprimals by more than 1.0 log CFU/cm(2) (P < 0.05). Storage for 21 days reduced surface populations of E. coli O157:H7 regardless of the inoculation level; however, the populations on LA- and control-treated lean surfaces of high- and low-inoculum-treated subprimals were not different after 21 days (P > 0.05). E. coli O157:H7 was detected in core samples from high-inoculum-treated steaks cooked to 55, 60, or 70°C. Conversely, E. coli O157:H7 was not detected in core samples from low-inoculum-treated steaks, regardless of the internal cooking temperature. These data suggest that LA- and storage-mediated reduction of pathogens on subprimals exposed to typical industry contamination levels (10(1) CFU/cm(2)) reduces the risk of pathogen translocation and subsequent survival after cooking.

Salmonella and Escherichia coli O157:H7 prevalence in cattle and on carcasses in a vertically integrated feedlot and harvest plant in Mexico.

To determine the prevalence of Salmonella and Escherichia coli O157:H7 in cattle feedlots and the impact of subsequent contamination on carcasses in a Mexican Federal Inspection Type Standards harvest facility, 250 animals were tagged and sampled in each step of the slaughter process. Samples were taken from hides and fecal grabs, and composite samples were taken from three anatomical carcass sites (hindshank, foreshank, and inside round) during the slaughter process, at preevisceration (PE), prior to entering the hot box (PHB), and after 24 h of dry chilling (DC). Additionally, 250 fecal samples were collected from the feedlot (FL), holding pens (HP), and intestinal feces (IF), and water samples were taken from the HP area. E. coli O157:H7 and Salmonella detection were carried out with the BAX System, immunomagnetic separation, and conventional methods. Overall Salmonella prevalence was 52.5%. The highest prevalence (92.4%) was found on hides, followed by feces from the HP (91.0%), FL (55.56%), PE (49.0%), IF (46.8%), and PHB (24.8%), for all sampling periods combined. The lowest prevalence of 6.0% was found after DC. The overall prevalence of E. coli O157:H7 was as follows: 11.7% for hides, 5.2% for IF, 2.7% for FL, 2.0% for HP, 0.8% for PE, 0.4% for PHB, and 0.4% for the cooler. High prevalence of Salmonella in IF and on hides present a significant risk factor for contamination by Salmonella at the different processing steps. These results serve as a warning as to the risks of contamination in meats for these pathogens and the importance of following good manufacturing practices during beef production processes.

Validation comparing the effectiveness of a lactic acid dip with a lactic acid spray for reducing Escherichia coli O157:H7, Salmonella, and non-O157 Shiga toxigenic Escherichia coli on beef trim and ground beef.

The objective of this research was to compare the effectiveness of two application methods (dip versus spray) of 4.4% lactic acid for reducing pathogens on inoculated beef trim and in ground beef. Beef trim inoculated with cocktail mixtures of E. coli O157:H7, non-O157 Shiga toxigenic E. coli (STEC), or Salmonella (10(5) to 10(6) CFU/g) at separate times was subjected to five treatments: lactic acid spray (LS), lactic acid dip (LD), water spray (WS), water dip (WD), and untreated control (CTL). Intervention effectiveness for pathogen reduction was measured at 1 and 20 h after treatment on beef trim. Trim was then ground and intervention effectiveness was measured 1 h, 24 h, 72 h, and 7 days after grinding. The LD treatment reduced all pathogens significantly (P < 0.05); E. coli O157:H7 was reduced by 0.91 to 1.41 log CFU/g on beef trim and ground beef, non-O157 STEC by 0.48 to 0.82 log CFU/g, and Salmonella by 0.51 to 0.81 log CFU/g. No other treatment significantly reduced any pathogen, although the WD treatment noticeably reduced (P > 0.05) both E. coli O157:H7 and non-O157 STEC populations compared with the CTL. The LS treatment reduced E. coli O157:H7 and Salmonella by up to 0.5 log CFU/g on beef trim, but these reduced counts did not significantly differ (P > 0.05) from the CTL counts. Overall, the LD treatment was most effective for reducing all pathogens and is the best of these options for improving the safety of beef trim and subsequently produced ground beef.

Survival trends of Staphylococcus aureus, Pseudomonas aeruginosa, and Clostridium perfringens in a sandy South Florida beach.

The search for alternative indicators of disease-risk from non-enteric pathogens at the beach revealed high densities of targeted bacteria. To explain the high numbers of potential non-enteric pathogens, Staphylococcus aureus and Pseudomonas aeruginosa, in beach sand, we investigated factors affecting their survival and distribution, as well as those of a potential fecal indicator, Clostridium perfringens. Results indicated greater S. aureus and P. aeruginosa survival and proliferation in sterile beach sand, than seawater, with diminished numbers upon exposure to natural micro-predators. C. perfringens remained relatively consistent with initial numbers. Intermediate sand particles (850 µm-2 mm) constituted the major micro-niche; creating implications for beach classification programs. Colonization of sterile sand boxes at the beach by S. aureus and P. aeruginosa confirmed the filtering action (>100×) of beach sand. The use of these potential pathogens in periodic sanitary evaluation of beach sand quality is indicated, regardless of the factors influencing their abundance.

Microbial quality of condensation in fresh and ready-to-eat processing facilities.

The objective was to determine the microbial risks associated with condensation in harvest, fabrication, and ready-to-eat (RTE) meat processing environments. A total of 2281 samples were collected before and during operation from areas of visible condensation, overhead pipes, and dripping pans in three plants each season during a one-year period. Significant interactions between season and plant type were observed for nearly all microorganisms, resulting in counts that were generally higher in the summer compared to other seasons. Aerobic plate counts ranged from non-detectable to 3.7log cfu100mL(-1) of condensation. Overall counts were so low that data had to be converted to results100mL(-1). Coliforms and Enterococci were not detectable in most condensation samples. Yeast and mold averaged less than 3.0log cfu100mL(-1) in all samples. Listeria spp. or Salmonella were each detected in only two samples. Condensation, present in harvest, fabrication, and RTE meat processing areas does not appear to contain microbial loads that will contaminate the product.

Validation of a lactic acid- and citric acid-based antimicrobial product for the reduction of Escherichia coli O157: H7 and Salmonella on beef tips and whole chicken carcasses.

The objectives of this study were to determine the effects of a lactic acid- and citric acid-based antimicrobial product on the reduction of Salmonella on whole broiler carcasses during processing and the reduction of Salmonella and Escherichia coli O157:H7 on beef trim. Freshly harvested broiler carcasses were inoculated with an inoculum of Salmonella strains to yield a 10(5) CFU/ml pathogen load on the surface of the carcass. The beef tips were inoculated as well with an inoculum of either E. coli O157:H7 or Salmonella to yield 10(4) CFU/100 cm(2). After 30 min for attachment, the broiler carcasses were treated with Chicxide applied for 5 s via a spray or immersed in Chicxide for 5, 10, or 20 s. Broiler carcasses were rinsed in poultry rinse bags with 400 ml of Butterfield's phosphate buffer in which Salmonella was enumerated from the diluents and Butterfield's phosphate. Chicxide significantly reduced Salmonella by 1.3 log CFU/ml with spray treatment and 2.3 log CFU/ml for all dip treatments. Following 30 min of attachment, the beef tips were placed into a spray cabinet with either Beefxide or sterilized water (control) and sprayed at 1 ft/2.5 s chain speed at 40 lb/in(2). The external surface of each beef tip was swabbed (100 cm(2)) to determine pathogen loads. Beefxide significantly reduced E. coli O157:H7 by 1.4 log CFU/100 cm(2) and Salmonella by 1.1 log CFU/100 cm(2) (P < 0.05) compared with the control samples.

Diversity and susceptibility of Enterococcus isolated from cattle before and after harvest.

To investigate evidence of cross-contamination and to determine patterns of antimicrobial drug susceptibility of Enterococcus isolates in a commercial cattle processing system, samples were collected from 60 cattle shipped to a commercial abattoir. Enterococcus isolates were recovered from fecal and hide samples collected immediately before shipment from a feedlot to the abattoir, from postexsanguination hide samples at the abattoir, and from carcass samples collected after hide removal (preevisceration) and in the cooler. Of the fecal samples, 53.9% were culture positive for Enterococcus. Of hide samples collected at the feedlot, 77.8% were positive for Enterococcus, significantly lower (P < 0.01) than the proportion of hides that were culture positive at the abattoir (96.1%). For preevisceration carcass samples, Enterococcus was recovered from 58.3% of carcasses. Only 8.3% of the carcasses sampled in the cooler yielded Enterococcus. Resistance among Enterococcus isolates was common regardless of the type or location of sample from which the isolate was recovered. All 279 Enterococcus isolates were resistant to at least one antimicrobial drug, and 179 (64.2%) of these isolates were resistant to at least six drugs. The most common resistance was to chloramphenicol (100% of isolates) followed by flavomycin (90.3%), lincomycin (87.8%), tylosin (78.5%), erythromycin (76.3%), tetracycline (58.9%), quinupristin-dalfopristin (47.7%), bacitracin (17.9), streptomycin (9.0%), ciprofloxacin (1.4%), linezolid (0.7%), and salinomycin (0.4%). Enterococcus isolates also were characterized using pulsed-field gel electrophoresis to evaluate molecular similarities. Similar or indistinguishable electrophoresis patterns were found among isolates recovered at the feedlot and in the plant, providing evidence that feedlot-origin bacterial isolates are being transferred from cattle to carcasses within the processing environment through cross-contamination.

Quality of and mold growth on white enriched bread for military rations following directional microwave treatment.

Meals ready-to-eat (MRE) are self-contained and flexible packages used by military personnel while in the field to store food for an extended period of time; however, inclusion of white bread is not a common practice because of short shelf life stability and spoilage. The objective of this study was to determine mold inhibition and quality attributes over a 60-d period after applying directional microwaves. Different bread loaves were used for quality and for microbiological experiments. For microbiological analysis, bread was exposed to 0-, 5-, 6-, 7-, 8-, 9-, and 10-s directional microwave treatments after inoculation with a 3 strain cocktail of common bread mold, stored at 25 degrees C for 60 d, and monitored for mold growth. For quality analysis, bread was exposed to 0- and 10-s treatments, stored at 25 degrees C, and moisture, water activity (a(w)), softness, and sensory analysis were analyzed on 0, 7, 14, 28, 45, and 60 d. There was no quantifiable mold present at day 0 when treated for 10 s (P < 0.05). By day 60, the 10-s treatment had significantly lower counts (< 3 CFU/g) than the remaining treatments. Directional microwave treatment significantly decreased the moisture content of the bread but was not detectable by consumers. There was no difference in a(w) through day 45 but differences were detected at day 60. There were no differences in softness (mm) of the treated and untreated bread through day 60. No differences were detected by sensory analysis. Directional microwaves can be used to extend the shelf life of white enriched bread up 2 mo with minimal mold growth and without detrimental effect to quality.

Survival of Escherichia coli O157:H7 in bovine feces over time under various temperature conditions.

Although Escherichia coli O157:H7 prevalence estimates in cattle have increased over time due to improvements in detection methods, fecal sample transport conditions from farm to microbiological laboratories for further analysis may be a factor for prevalence underestimation. The objective of this study was to compare and determine the survival characteristics of E. coli O157:H7 in bovine feces under various storage conditions that could be encountered during transport. Fecal pats were inoculated with a four-strain cocktail of antibiotic-resistant E. coli O157:H7 to contain approximately 1 x 10(5) CFU/g. Inoculated and control samples were taken after 0, 24, 48, 120, and 168 h at each storage temperature and examined for presence and numbers of E. coli O157:H7. Each sample was subdivided and placed at each of the four following temperatures: 37, 23, 4.4 degrees C, and in a plastic cooler with refrigerant packs (0, 4, 4, 21, and 23 degrees C at five sampling times, respectively) to simulate transportation conditions. A statistically significant decrease in the population of the pathogen was observed after 48 h in samples held at 37 degrees C (P < 0.01) and after 168 h at 4.4 degrees C (P = 0.02). At 37 degrees C, E. coli O157:H7 was not detected after 48 h, either by direct plating (P < 0.01) or by immunomagnetic separation. Overall, the results of this study showed that E. coli O157:H7 survived without significant detriment in bovine fecal material inside the cooler for up to 168 h. These results indicate that shipment and storage under these conditions before microbiological analysis would be acceptable and should not affect pathogen detection.

Diagnostico y tratamiento del sangrado uterino durante TRE/TRH / Abnormal uterine bleeding and HRT

La Terapia de Reemplazo Hormonal (TRH) produce evidentes efectos benéficos durante la postmenopausia. Su administración es, en general, bien tolerada. Sin embargo, uno de los principales efectos adversos de la TRH, es el sangrado irregular, el cual produce ansiedad tanto en la paciente como en el médico. Existen diversos compuestos y esquemas de administración de TRH, los cuales se describen y analizan al igual como las alternativas de manejo del sangrado