RESUMO
Nutrient and soil loss from agricultural areas impairs surface water quality globally. In the Great Lakes region, increases in the frequency and magnitude of harmful and nuisance algal blooms in freshwater lakes have been linked to elevated phosphorus (P) losses from agricultural fields, some of which are transported via tile drainage. This study examined whether concentrations and loads of P fractions, total suspended sediments (TSS), nitrate (NO3 - ), and ammonium (NH4 + ) in tile drainage in a clay soil differed between a continuous no-till system combining cover crops and surface broadcast fertilizer (no-till cover crop [NTCC]), and a more conventional tillage system with shallow tillage, fertilizer incorporation and limited use of cover crops (conventional conservation-till, CT). Both sites had modest soil fertility levels. Year-round, high-frequency observations of tile drainage flow and chemistry are described over 4 full water years and related to management practices on the associated fields. There were similar water yields in tile drainage between the two systems; however, losses of TSS, particulate P (PP), and NO3 - were consistently greater from the CT site, which received larger quantities of fertilizer. In contrast, dissolved reactive P (DRP) losses were considerably greater from the NTCC site, offsetting the lower PP losses, such that there was little difference in TP losses between sites. Approximately 60% of the DRP losses from the NTCC site over the 4 years were associated with incidental losses following surface application of fertilizer in fall. This study provides insight into trade-offs in controlling losses of different nutrient fractions using different management systems.
Assuntos
Fertilizantes , Solo , Agricultura , Argila , Fósforo , Nutrientes , Movimentos da ÁguaRESUMO
The eutrophication of freshwater systems is a pervasive issue in North America and elsewhere, which has been linked to elevated phosphorus (P) loading from watersheds. Most excess P is thought to originate from non-point agricultural sources, and less attention has been given to small rural point sources, such as bunker silos on livestock farms. Sophisticated management practices are rarely used to attenuate nutrients from bunker silo effluent, leaving simple vegetated buffer strips or riparian zones to protect surface water; however, the efficacy of these systems or larger constructed treatment systems is unclear. This study compared two systems receiving bunker silo effluent, one a natural riparian system with a vegetated buffer strip that is the most common practice and the other a constructed treatment system with a forebay, slag filter, and swale. The study quantified P retention within various subsections of each system and characterized the forms of stored P to infer the potential for remobilization. Results indicate that soils receiving bunker silo effluent represent considerable stores of legacy P in the landscape (750 and 3400 kg ha-1), the majority of which is stored in labile forms that may be vulnerable to remobilization under the waterlogged conditions that often occur in management practices and riparian zones. Some areas of the systems were able to store considerably more P than others, with the slag filter showing the greatest treatment efficacy. Spatial variability in stored P was apparent, where sections of the systems that directly received effluent retained more P than sections located farther away from bunker silos (indirect inputs). Results indicate that passive treatment systems become P saturated over time, limiting their longterm P removal efficacy. The efficacy of these systems may be improved with the inclusion of sorptive materials as a slag filter within the constructed treatment system significantly increased the life expectancy of that system. Greater understanding of both quantity and forms of P retained in systems and soils receiving bunker silo effluent will help develop management strategies that are more effective and longer-lasting for reducing excess P losses to surface water bodies.
Assuntos
Poluentes do Solo , Poluentes Químicos da Água , Agricultura , Fósforo , Solo , Poluentes do Solo/análise , Água , Poluentes Químicos da Água/análiseRESUMO
Quantifying spatial and temporal fluxes of phosphorus (P) within and among agricultural production systems is critical for sustaining agricultural production while minimizing environmental impacts. To better understand P fluxes in agricultural landscapes, P-FLUX, a detailed and harmonized dataset of P inputs, outputs, and budgets, as well as estimated uncertainties for each P flux and budget, was developed. Data were collected from 24 research sites and 61 production systems through the Long-term Agroecosystem Research (LTAR) network and partner organizations spanning 22 U.S. states and 2 Canadian provinces. The objectives of this paper are to (a) present and provide a description of the P-FLUX dataset, (b) provide summary analyses of the agricultural production systems included in the dataset and the variability in P inputs and outputs across systems, and (c) provide details for accessing the dataset, dataset limitations, and an example of future use. P-FLUX includes information on select site characteristics (area, soil series), crop rotation, P inputs (P application rate, source, timing, placement, P in irrigation water, atmospheric deposition), P outputs (crop removal, hydrologic losses), P budgets (agronomic budget, overall budget), uncertainties associated with each flux and budget, and data sources. Phosphorus fluxes and budgets vary across agricultural production systems and are useful resources to improve P use efficiency and develop management strategies to mitigate environmental impacts of agricultural systems. P-FLUX is available for download through the USDA Ag Data Commons (https://doi.org/10.15482/USDA.ADC/1523365).
Assuntos
Agricultura , Fósforo , Canadá , Fósforo/análise , Solo , Estados Unidos , ÁguaRESUMO
This study quantified the contributions of overland and tile flow to total runoff (sum of overland and tile flow) and nutrient losses in a Vertisolic soil in the Red River valley (Manitoba, Canada), a region with a cold climate where tile drainage is rapidly expanding. Most annual runoff occurred as overland flow (72-89%), during spring snowmelt and large spring and summer storms. Tile drains did not flow in early spring due to frozen ground. Although tiles flowed in late spring and summer (33-100% of event flow), this represented a small volume of annual runoff (10-25%), which is in stark contrast with what has been observed in other tile-drained landscapes. Median daily flow-weighted mean concentrations of soluble reactive P (SRP) and total P (TP) were significantly greater in overland flow than in tile flow ( < 0.001), but the reverse pattern was observed for NO-N ( < 0.001). Overland flow was the primary export pathway for both P and NO-N, accounting for >95% of annual SRP and TP and 50 to 60% of annual NO-N losses. Data suggest that tile drains do not exacerbate P export from Vertisols in the Red River valley because they are decoupled from the surface by soil-ice during snowmelt, which is the primary time for P loss. However, NO-N loading to downstream water bodies may be exacerbated by tiles, particularly during spring and summer storms after fertilizer application.
Assuntos
Fósforo , Movimentos da Água , Agricultura , Canadá , Manitoba , NutrientesRESUMO
Phosphorus (P) loss in agricultural discharge has typically been associated with surface runoff; however, tile drains have been identified as a key P pathway due to preferential transport. Identifying when and where these pathways are active may establish high-risk periods and regions that are vulnerable for P loss. A synthesis of high-frequency, runoff data from eight cropped fields across the Great Lakes region of North America over a 3-yr period showed that both surface and tile flow occurred year-round, although tile flow occurred more frequently. The relative timing of surface and tile flow activation was classified into four response types to infer runoff-generation processes. Response types were found to vary with season and soil texture. In most events across all sites, tile responses preceded surface flow, whereas the occurrence of surface flow prior to tile flow was uncommon. The simultaneous activation of pathways, indicating rapid connectivity through the vadose zone, was seldom observed at the loam sites but occurred at clay sites during spring and summer. Surface flow at the loam sites was often generated as saturation-excess, a phenomenon rarely observed on the clay sites. Contrary to expectations, significant differences in P loads in tiles were not apparent under the different response types. This may be due to the frequency of the water quality sampling or may indicate that factors other than surface-tile hydrologic connectivity drive tile P concentrations. This work provides new insight into spatial and temporal differences in runoff mechanisms in tile-drained landscapes.
Assuntos
Hidrologia , Fósforo , Agricultura , Great Lakes Region , SoloRESUMO
Phosphorus (P) plays a crucial role in agriculture as a primary fertilizer nutrient-and as a cause of the eutrophication of surface waters. Despite decades of efforts to keep P on agricultural fields and reduce losses to waterways, frequent algal blooms persist, triggering not only ecological disruption but also economic, social, and political consequences. We investigate historical and persistent factors affecting agricultural P mitigation in a transect of major watersheds across North America: Lake Winnipeg, Lake Erie, the Chesapeake Bay, and Lake Okeechobee/Everglades. These water bodies span 26 degrees of latitude, from the cold climate of central Canada to the subtropics of the southeastern United States. These water bodies and their associated watersheds have tracked trajectories of P mitigation that manifest remarkable similarities, and all have faced challenges in the application of science to agricultural management that continue to this day. An evolution of knowledge and experience in watershed P mitigation calls into question uniform solutions as well as efforts to transfer strategies from other arenas. As a result, there is a need to admit to shortcomings of past approaches, plotting a future for watershed P mitigation that accepts the sometimes two-sided nature of Hennig Brandt's "Devil's Element."
Assuntos
Eutrofização , Fósforo , Agricultura , Atitude , Canadá , América do Norte , Sudeste dos Estados UnidosRESUMO
Malaria, a major cause of morbidity and mortality, is the most prevalent vector borne disease in Baringo County; a region which has varied house designs in arid and semi-arid areas. This study investigated the association between house structures and indoor-malaria vector abundance in Baringo County. The density of malaria vectors in houses with open eaves was higher than that for houses with closed eaves. Grass thatched roof houses had higher density of malaria vectors than corrugated iron sheet roofs. Similarly, mud walled houses had higher vector density than other wall types. Houses in the riverine zone were significantly associated with malaria vector abundance (p<0.000) possibly due to more varied house structures. In Kamnarok village within riverine zone, a house made of grass thatched roof and mud wall but raised on stilts with domestic animals (sheep/goats) kept at the lower level had lower mosquito density (5.8 per collection) than ordinary houses made of same materials but at ground level (30.5 mosquitoes per collection), suggestive of a change in behavior of mosquito feeding and resting. House modifications such as screening of eaves, improvement of construction material and building stilted houses can be incorporated in the integrated vector management (IVM) strategy to complement insecticide treated bed nets and indoor residual spray to reduce indoor malaria vector density.
Assuntos
Habitação , Malária/prevenção & controle , Animais , Anopheles/fisiologia , Humanos , Quênia/epidemiologia , Gado/parasitologia , Malária/epidemiologia , Mosquitos Vetores , OvinosRESUMO
Epidemiological evidence suggests that exposure to infection during early development increases the risk for neurodevelopmental disorders associated with symptoms such as a decreased desire to engage in social interactions. In animals, disruptions in social behavior can be modelled by administering bacterial mimetics such as liposaccharide (LPS). However, when evaluating social interactions in the laboratory, attention is rarely directed on the reciprocal relationship as a whole, which is important as peers may drive social withdrawal. Previously, we have shown that male adolescent rats treated neonatally (n) with LPS receive less contact from their conspecifics in a social interaction test, and that this effect is mediated through olfactory communication. In the present study, we reconfirmed this effect using a more direct social test and evaluated the hypothesis that changes in the microbiome underlie the olfactory induced social aversion. Male and female Sprague-Dawley rats were administered nLPS (50⯵g/kg, i.p) or nSaline on postnatal days (P)3 and 5. On P40, adolescent nLPS treated males received less contact in a social preference test compared to nSaline treated controls, an effect not observed in females. To confirm that nLPS led male rats to elicit a scent cue, resulting in social aversion, a subset of neurotypical conspecifics underwent an anosmia procedure that disrupted their olfactory processing via olfactory neuroepithelium degeneration. This normalized the contact that they directed towards nLPS and nSaline male rats. Although 16â¯s rRNA sequencing failed to detect significant differences in bacterial phyla across either sex or neonatal treatment, treating male nLPS rats with an antibiotic cocktail, which induced clear changes in microbial communities, diminished the social rejection effect. Therefore, manipulation of the microbiome appears to affect social communication where there exists an underlying deficit. Moreover, our data reaffirm that social engagement is a reciprocal process and the behavior of all individuals within a dynamic interaction should be evaluated.
Assuntos
Antibacterianos/farmacologia , Inflamação/psicologia , Comportamento Social , Animais , Animais Recém-Nascidos , Encéfalo/efeitos dos fármacos , Encéfalo/crescimento & desenvolvimento , Encéfalo/metabolismo , Modelos Animais de Doenças , Escherichia coli , Feminino , Expressão Gênica/efeitos dos fármacos , Expressão Gênica/imunologia , Lipopolissacarídeos , Masculino , Microbiota/efeitos dos fármacos , Transtornos do Olfato/microbiologia , Transtornos do Olfato/psicologia , Ocitocina/metabolismo , RNA Bacteriano , RNA Ribossômico 16S , Ratos Sprague-Dawley , Fatores Sexuais , OlfatoRESUMO
Exposure to early-life inflammation results in time-of-challenge-dependent changes in both brain and behavior. The consequences of this neural and behavioral reprogramming are most often reported in adulthood. However, the trajectory for the expression of these various changes is not well delineated, particularly between the juvenile and adult phases of development. Moreover, interventions to protect against these neurodevelopmental disruptions are rarely evaluated. Here, female Sprague-Dawley rats were housed in either environmental enrichment (EE) or standard care (SC) and their male and female offspring were administered 50 µg/kg i.p. of lipopolysaccharide (LPS) or pyrogen-free saline in a dual-administration neonatal protocol. All animals maintained their respective housing assignments from breeding until the end of the study. LPS exposure on postnatal days (P) 3 and 5 of life resulted in differential expression of emotional and cognitive disruptions and evidence of oxidative stress across development. Specifically, social behavior was reduced in neonatal-treated (n)LPS animals at adolescence (P40), but not adulthood (P70). In contrast, male nLPS rats exhibited intact spatial memory as adolescents which was impaired in later life. Moreover, these males had decreased prefrontal cortex levels of glutathione at P40, which was normalized in adult animals. Notably, EE appeared to offer some protection against the consequences of inflammation on juvenile social behavior and fully prevented reduced glutathione levels in the juvenile prefrontal cortex. Combined, these time-dependent effects provide evidence that early-life inflammation interacts with other developmental variables, specifically puberty and EE, in the expression (and prevention) of select behavioral and molecular programs.
Assuntos
Deficiências do Desenvolvimento/etiologia , Inflamação/complicações , Transtornos Mentais/etiologia , Estresse Oxidativo/fisiologia , Fatores Etários , Animais , Animais Recém-Nascidos , Corticosterona/sangue , Deficiências do Desenvolvimento/metabolismo , Progressão da Doença , Feminino , Glutationa/metabolismo , Inflamação/sangue , Inflamação/induzido quimicamente , Inflamação/patologia , Lipopolissacarídeos/toxicidade , Masculino , Comportamento Materno , Transtornos Mentais/sangue , Estresse Oxidativo/efeitos dos fármacos , Córtex Pré-Frontal/metabolismo , Ratos , Ratos Sprague-Dawley , Fatores Sexuais , Comportamento Social , Estatísticas não Paramétricas , Fatores de TempoRESUMO
Early-life exposure to inflammation has been associated with several behavioral and cognitive deficits detected in adulthood. However, early behavioral changes have not been well described in rodent models of infection, specifically with respect to social behavior. In the present work we show that lipopolysaccharide (LPS) challenge at 3 and 5days of age reduced overall social contact time in male juvenile rats, primarily mediated by the amount of contact they received from a novel conspecific. Given that there are important sensory, motor, and motivational components that underlie social interaction we sought to uncover the mechanism(s) responsible for the reduced social contact directed towards neonatal (n)LPS treated animals. Using an intranasal perfusion procedure, we induced a ZnSO4 lesion in a subset of novel conspecifics, effectively disrupting their olfactory processing via olfactory neuroepithelium degeneration. Overall, this procedure equalized the amount of social contact directed towards nLPS animals compared to nsaline rats. To determine whether nLPS disrupted auditory communication we evaluated ultrasonic vocalizations (USVs) for the total number and duration of calls, and the average duration and frequency from each vocalization recording. There were no differences in USVs across treatment groups. Treating nLPS rats with diazepam maintained the level of social contact they initiated, compared to the stress-induced decrease observed in their saline treated counterparts. However, diazepam did not stabilize the amount of contact directed towards them. Together, this indicates that neither vocalized motor pathways nor anxiety cues, mediated by auditory/motor communication, are involved in the social deficits following nLPS. Instead, our data suggest that olfactory indicators, likely mediated through microbiota/immunomodulatory scent signals underlie the reductions in social contact that follow neonatal inflammation.
Assuntos
Inflamação/fisiopatologia , Inflamação/psicologia , Distância Psicológica , Olfato/fisiologia , Administração Intranasal , Animais , Animais Recém-Nascidos , Ansiolíticos/farmacologia , Comportamento Animal/efeitos dos fármacos , Sinais (Psicologia) , Diazepam/farmacologia , Feminino , Inflamação/induzido quimicamente , Lipopolissacarídeos , Masculino , Transtornos do Olfato/induzido quimicamente , Ratos , Ratos Sprague-Dawley , Vocalização Animal , Sulfato de Zinco/farmacologiaRESUMO
BACKGROUND: Infective endocarditis (IE) causes substantial morbidity and mortality. Patient and pathogen profiles, as well as microbiological and operative strategies, continue to evolve. The impact of these changes requires evaluation to inform optimum management and identify individuals at high risk of early mortality. AIM: Identification of clinical and microbiological features, and surgical outcomes, among patients presenting to a UK tertiary cardiothoracic centre for surgical management of IE between 1998 and 2010. DESIGN: Retrospective observational cohort study. METHODS: Clinical, biochemical, microbiological and echocardiographic data were identified from clinical records. Principal outcomes were all-cause 28-day mortality and duration of post-operative admission. RESULTS: Patients (n = 336) were predominantly male (75.0%); median age 52 years (IQR = 41-67). Most cases involved the aortic (56.0%) or mitral (53.9%) valves. Microbiological diagnoses, obtained in 288 (85.7%) patients, included streptococci (45.2%); staphylococci (34.5%); Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella (HACEK) organisms (3.0%); and fungi (1.8%); 11.3% had polymicrobial infection. Valve replacement in 308 (91.7%) patients included mechanical prostheses (69.8%), xenografts (24.0%) and homografts (6.2%). Early mortality was 12.2%, but fell progressively during the study (P = 0.02), as did median duration of post-operative admission (33.5 to 10.5 days; P = 0.0003). Multivariable analysis showed previous cardiothoracic surgery (OR = 3.85, P = 0.03), neutrophil count (OR = 2.27, P = 0.05), albumin (OR = 0.94, P = 0.04) and urea (OR = 2.63, P < 0.001) predicted early mortality. CONCLUSIONS: This study demonstrates reduced post-operative early mortality and duration of hospital admission for IE patients over the past 13 years. Biomarkers (previous cardiothoracic surgery, neutrophil count, albumin and urea), predictive of early post-operative mortality, require prospective evaluation to refine algorithms, further improve outcomes and reduce healthcare costs associated with IE.
Assuntos
Endocardite Bacteriana/cirurgia , Infecções por Bactérias Gram-Negativas/cirurgia , Infecções por Bactérias Gram-Positivas/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Micoses/cirurgia , Adulto , Idoso , Ecocardiografia , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/mortalidade , Feminino , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/mortalidade , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/mortalidade , Doenças das Valvas Cardíacas/microbiologia , Doenças das Valvas Cardíacas/mortalidade , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Micoses/microbiologia , Micoses/mortalidade , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/complicações , Resultado do TratamentoRESUMO
PURPOSE OF REVIEW: We present the key advances in the infections that clinicians conventionally associate with atypical pneumonia: legionellosis, Mycoplasma pneumonia, Chlamydophila species pneumonia and Q fever. RECENT FINDINGS: There have been significant developments in molecular diagnosis to include Mycoplasma pneumoniae and Chlamydophila pneumoniae in multiplex PCR of respiratory specimens. There are diagnostic challenges in distinguishing carriage from infection, which is recognized in C. pneumoniae and now also evident in M. pneumoniae. Macrolide-resistant M. pneumoniae has emerged in Asia. There are new antimicrobials on the horizon in the ketolide class with activity against typical and atypical pathogens and useful empirical agents. SUMMARY: There are few advances in our knowledge of the epidemiology of atypical pathogens or the effectiveness of antimicrobial therapy--empirical or pathogen specific. However, if molecular testing becomes widely implemented, there will be an increased understanding of the epidemiology and presentation of atypical pneumonia and a shift to more targeted antimicrobial therapy.
Assuntos
Infecções por Chlamydophila/diagnóstico , Infecções Comunitárias Adquiridas/diagnóstico , Legionelose/diagnóstico , Pneumonia Bacteriana/diagnóstico , Pneumonia por Mycoplasma/diagnóstico , Psitacose/diagnóstico , Febre Q/diagnóstico , Antibacterianos/uso terapêutico , Anticorpos Antibacterianos/isolamento & purificação , Infecções por Chlamydophila/tratamento farmacológico , Infecções por Chlamydophila/transmissão , Chlamydophila pneumoniae/isolamento & purificação , Chlamydophila psittaci/isolamento & purificação , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/transmissão , Coxiella burnetii/isolamento & purificação , Feminino , Humanos , Legionelose/tratamento farmacológico , Legionelose/transmissão , Masculino , Mycoplasma pneumoniae/isolamento & purificação , Técnicas de Amplificação de Ácido Nucleico/métodos , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/transmissão , Pneumonia por Mycoplasma/tratamento farmacológico , Pneumonia por Mycoplasma/transmissão , Psitacose/tratamento farmacológico , Psitacose/transmissão , Febre Q/tratamento farmacológico , Febre Q/transmissãoRESUMO
BACKGROUND: Environmental surfaces have long been suspected to be a reservoir that could contribute to the presence of micro-organisms in healthcare facilities. The objective of this study was to evaluate the effect of providing weekly feedback to the housekeeping staff in improving and sustaining cleaning compliance when using ultraviolet visible marker (UVM) as an audit tool. METHODS: The housekeeping staff selected 90% as the cleaning compliance target. The UVM was applied to the toilet seat, sink, soap dispenser and door knob surfaces within the patient's washrooms on consecutive weekdays. The study included three arms: staff in arm 1 received cleaning compliance feedback throughout the 24-week study period, arm 2 and arm 3 staff received feedback for weeks 13-24 and weeks 1-12, respectively. Feedback was also provided to housekeeping staff by posting graphs on the wards and in the housekeeping office. FINDINGS: A pre-study audit showed 66.9%, 66.5% and 66.4% cleaning compliance for arms 1, 2 and 3 respectively. While receiving weekly feedback, all three arms demonstrated significantly improved cleaning compliance (86.7%, 80.4% and 73.7% for arms 1, 2 and 3, respectively). The use of casual staff may have contributed to difficulty in achieving better cleaning compliance as arms 1, 2 and 3 had 16.1%, 26% and 40.3% of shifts filled by casual staff, respectively. CONCLUSIONS: The use of UVM as an audit tool combined with weekly feedback of results to housekeeping staff resulted in significant, sustained improvement in the overall level of cleaning compliance of housekeeping staff.
Assuntos
Desinfecção/normas , Fidelidade a Diretrizes/normas , Instalações de Saúde , Zeladoria Hospitalar/normas , Indicadores e Reagentes , Controle de Qualidade , Raios Ultravioleta , Desinfecção/métodos , Zeladoria Hospitalar/métodos , HumanosRESUMO
Human campylobacteriosis exhibits a distinctive seasonality in temperate regions. This paper aims to identify the origins of this seasonality. Clinical isolates [typed by multi-locus sequence typing (MLST)] and epidemiological data were collected from Scotland. Young rural children were found to have an increased burden of disease in the late spring due to strains of non-chicken origin (e.g. ruminant and wild bird strains from environmental sources). In contrast the adult population had an extended summer peak associated with chicken strains. Travel abroad and UK mainland travel were associated with up to 17% and 18% of cases, respectively. International strains were associated with chicken, had a higher diversity than indigenous strains and a different spectrum of MLST types representative of these countries. Integrating empirical epidemiology and molecular subtyping can successfully elucidate the seasonal components of human campylobacteriosis. The findings will enable public health officials to focus strategies to reduce the disease burden.
Assuntos
Infecções por Campylobacter/etiologia , Adolescente , Adulto , Fatores Etários , Idoso , Animais , Animais Selvagens/microbiologia , Aves/microbiologia , Infecções por Campylobacter/epidemiologia , Galinhas/microbiologia , Criança , Pré-Escolar , Humanos , Incidência , Pessoa de Meia-Idade , Epidemiologia Molecular/métodos , Tipagem de Sequências Multilocus , População Rural/estatística & dados numéricos , Escócia/epidemiologia , Estações do Ano , Viagem , População Urbana/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: Empyema is an increasingly frequent clinical problem worldwide, and has substantial morbidity and mortality. Our objectives were to identify the clinical, surgical and microbiological features, and management outcomes, of empyema. METHODS: A retrospective observational study over 12 years (1999-2010) was carried out at The Heart Hospital, London, United Kingdom. Patients with empyema were identified by screening the hospital electronic 'Clinical Data Repository'. Demographics, clinical and microbiological characteristics, underlying risk factors, peri-operative blood tests, treatment and outcomes were identified. Univariable and multivariable statistical analyses were performed. RESULTS: Patients (nâ=â406) were predominantly male (74.1%); median ageâ=â53 years (IQRâ=â37-69). Most empyema were community-acquired (87.4%) and right-sided (57.4%). Microbiological diagnosis was obtained in 229 (56.4%) patients, and included streptococci (16.3%), staphylococci (15.5%), gram-negative organisms (8.9%), anaerobes (5.7%), pseudomonads (4.4%) and mycobacteria (9.1%); 8.4% were polymicrobial. Most (68%) cases were managed by open thoracotomy and decortication. Video-assisted thoracoscopic surgery (VATS) reduced hospitalisation from 10 to seven days (Pâ=â0.0005). All-cause complication rate was 25.1%, and 28 day mortality 5.7%. Predictors of early mortality included: older age (Pâ=â0.006), major co-morbidity (Pâ=â0.01), malnutrition (Pâ=â0.001), elevated red cell distribution width (RDW, P<0.001) and serum alkaline phosphatase (Pâ=â0.004), and reduced serum albumin (Pâ=â0.01) and haemoglobin (Pâ=â0.04). CONCLUSIONS: Empyema remains an important cause of morbidity and hospital admissions. Microbiological diagnosis was only achieved in just over 50% of cases, and tuberculosis is a notable causative organism. Treatment of empyema with VATS may reduce duration of hospital stay. Raised RDW appears to associate with early mortality.
Assuntos
Empiema Pleural/epidemiologia , Empiema Pleural/microbiologia , Adulto , Idoso , Empiema Pleural/mortalidade , Empiema Pleural/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia Torácica VídeoassistidaAssuntos
Aneurisma Infectado/diagnóstico , Aneurisma Aórtico/diagnóstico , Aneurisma Ilíaco/diagnóstico , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Aneurisma Infectado/complicações , Aneurisma Aórtico/complicações , Vértebras Cervicais/diagnóstico por imagem , Discite/complicações , Discite/diagnóstico , Evolução Fatal , Artéria Femoral , Fluordesoxiglucose F18 , Humanos , Aneurisma Ilíaco/complicações , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Artéria Poplítea , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Sepse/complicações , Infecções Estafilocócicas/complicações , Tomografia Computadorizada por Raios XRESUMO
Campylobacter prevalence from retail liver (chicken, cattle, pig and sheep) was found to be 81%, 69%, 79% and 78% respectively. Molecular source attribution demonstrated that strains from chicken liver were most similar to those found commonly in humans. This provides further evidence of liver being a probable source of human infection.
Assuntos
Campylobacter/isolamento & purificação , Fígado/microbiologia , Carne/microbiologia , Animais , Bovinos , Galinhas , Microbiologia de Alimentos , Prevalência , Ovinos , SuínosRESUMO
AIMS: To assess whether flies and slugs acquire strains of Campylobacter jejuni and Campylobacter coli present in local ruminant faeces. METHODS AND RESULTS: Campylobacter was cultured from flies, slugs and ruminant faeces that were collected from a single farm in Scotland over a 19-week period. The isolates were typed using multi-locus sequence typing (MLST) and compared with isolates from cattle and sheep faeces. Campylobacter jejuni and Camp. coli were isolated from 5·8% (n=155, average of 75 flies per pool) and 13·3% (n=15, average of 8·5 slugs per pool) of pooled fly and slug samples, respectively. The most common sequence type (ST) in flies was Camp. coli ST-962 (approx. 40%) regardless of the prevalence in local cattle (2·3%) or sheep (25·0%) faeces. Two positive slug pools generated the same ST that has not been reported elsewhere. CONCLUSIONS: Despite their low carriage rate, flies are able to acquire Campylobacter STs that are locally present, although the subset carried may be biased when compared to local source. Slugs were shown to carry a previously unreported Campylobacter ST. SIGNIFICANCE AND IMPACT OF THE STUDY: This study has demonstrated that flies carry viable Campylobacter and may contribute to the transfer of STs within and between groups of animals on farms. Further, they may therefore present a risk to human health via their contact with ready-to-eat foods or surfaces.
Assuntos
Campylobacter coli/classificação , Campylobacter jejuni/classificação , Dípteros/microbiologia , Fezes/microbiologia , Gastrópodes/microbiologia , Animais , Campylobacter coli/genética , Campylobacter coli/isolamento & purificação , Campylobacter jejuni/genética , Campylobacter jejuni/isolamento & purificação , Bovinos , Tipagem de Sequências Multilocus , Escócia , Ovinos/microbiologiaAssuntos
Dacriocistite/diagnóstico , Tuberculose Ocular/diagnóstico , Adolescente , Antituberculosos/uso terapêutico , Dacriocistite/diagnóstico por imagem , Dacriocistite/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Orbitárias/diagnóstico , Rabdomiossarcoma/diagnóstico , Tomografia Computadorizada por Raios X , Tuberculose Ocular/diagnóstico por imagem , Tuberculose Ocular/tratamento farmacológicoRESUMO
An outbreak of campylobacteriosis affected approximately one-half of 165 people attending an annual farmers' dance in Montrose, Scotland, in November 2005. Epidemiological investigations, including a cohort study (n = 164), identified chicken liver paté as the most likely vehicle of infection. Paté preparation involved deliberate undercooking of chicken livers by flash-frying, followed by mechanical homogenization. Typing of 32 Campylobacter strains (isolated from submitted stools) by multilocus sequence typing identified four distinct clades of Campylobacter jejuni. There was good agreement when isolates were typed by Penner serotyping, pulsed-field gel electrophoresis, and flaA short variable region sequencing but poorer agreement with phage and antibiotic susceptibility testing. At least three attendees were coinfected with two Campylobacter strains each. The outbreak was probably due to several livers contributing Campylobacter strains that survived undercooking and were dispersed throughout the paté. The study highlights improper culinary procedures as a potential human health risk and provides a striking counterexample to the "dominant outbreak strain" view of point source outbreaks of food-borne infections. It also demonstrates that previous exposure to biologically plausible sources of Campylobacter may confer protection against subsequent infection.